Article Text
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.
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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.
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.
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