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Critical care
Original research
Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study
  1. Joshua McLarty1,2,
  2. Edward Litton3,4,
  3. Abigail Beane5,6,
  4. Diptesh Aryal7,
  5. Michael Bailey2,
  6. Stepani Bendel8,9,
  7. Gaston Burghi10,
  8. Steffen Christensen11,
  9. Christian Fynbo Christiansen12,
  10. Dave A Dongelmans13,14,
  11. Ariel L Fernandez15,
  12. Aniruddha Ghose16,
  13. Ros Hall17,
  14. Rashan Haniffa5,6,
  15. Madiha Hashmi18,
  16. Satoru Hashimoto19,20,
  17. Nao Ichihara21,
  18. Bharath Kumar Tirupakuzhi Vijayaraghavan22,23,
  19. Nazir I Lone24,
  20. Maria del Pilar Arias López25,26,
  21. Mohamed Basri Mat Nor27,
  22. Hiroshi Okamoto28,
  23. Dilanthi Priyadarshani29,
  24. Matti Reinikainen8,9,
  25. Marcio Soares30,
  26. David Pilcher1,2,
  27. Jorge Salluh30,31
  28. Linking of Global Intensive Care (LOGIC) Collaboration
  1. 1 Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
  3. 3 St John of God Hospital Subiaco, Perth, Western Australia, Australia
  4. 4 The University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia
  5. 5 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
  6. 6 Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
  7. 7 Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
  8. 8 Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
  9. 9 Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
  10. 10 Hospital Maciel, Montevideo, Uruguay
  11. 11 Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
  12. 12 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
  13. 13 Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  14. 14 National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
  15. 15 SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
  16. 16 Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
  17. 17 Public Health Scotland, Edinburgh, UK
  18. 18 Ziauddin University, Karachi, Pakistan
  19. 19 Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
  20. 20 Japanese Intensive Care PAtient Database (JIPAD), Tokyo, Japan
  21. 21 The University of Tokyo, Bunkyo-ku, Japan
  22. 22 The George Institute for Global Health India, New Delhi, Delhi, India
  23. 23 Department of Critical Care Medicine, Apollo Main Hospital, Chennai, Tamil Nadu, India
  24. 24 Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  25. 25 Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
  26. 26 PICU, Hospital de Ninos R Gutierres, Buenos Aires, Argentina
  27. 27 Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
  28. 28 St Luke's International Hospital, Tokyo, Japan
  29. 29 NICS-MORU, Colombo, Sri Lanka
  30. 30 D'Or Institute for Research and Education, Rio de Janeiro, Brazil
  31. 31 Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
  1. Correspondence to Dr Joshua McLarty, Alfred Hospital, Melbourne 3004, Victoria, Australia; j.mclarty{at}alfred.org.au

Abstract

Background The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment.

Methods We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry.

Findings Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes.

Interpretation Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.

  • COVID-19
  • Critical Care
  • Clinical Epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. Requests for data will be subject to the requirements and policies of each CQR. Requests should be directed to the corresponding author.

https://doi.org/10.1136/thorax-2022-219592

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Requests for data will be subject to the requirements and policies of each CQR. Requests should be directed to the corresponding author.

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    Footnotes

    • Twitter @Burghi G, @ChristianFynbo, @ICUlone, @pilar260

    • Collaborators The Linking of Global Intensive Care collaboration was integral in connecting participating registries to collaborate on this study.

    • Contributors DP, EL and JS conceived the study and developed the study design. Data were collected and provided by DP, EL, JS, AB, DA, MBMN, SB, GB, SC, CFC, DAD, ALF, AG, RoH, RaH, MH, SH, NI, BKTV, NIL, MdPAL, HO, DP, MR and MS. JM and DP accessed and verified the data. JM analysed the data, with assistance from DP and MB. JM, DP, EL and JS wrote the initial draft, and all authors were involved in commenting on subsequent revisions. JM is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DP and Dr EL are members of the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation management committee. AB is funded by Wellcome. JS and MS are cofounders and shareholders of Epimed Solutions, a healthcare cloud-based analytics company. They are also supported in part by individual research grants from CNPq and FAPERJ. SB is the current chair, and MR is the past chair of the Finnish Intensive Care Consortium (both unpaid). DAD is unpaid chair of NICE foundation. NI's primary affiliation is the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by National Clinical Database, Johnson & Johnson K.K., and Nipro corporation. BKTV is the National Coordinator for the Indian Registry of IntenSive care (IRIS) and is supported for 0.5 FTE by funding from the Wellcome Trust, UK. The remaining authors have no conflicts of interest to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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