Epidemiology of Organ Failure Before and During the SARS-CoV-2 Pandemic

Abstract

Rationale: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to elevated inhospital morbidity and mortality. We aim to understand the frequency, timing, and outcomes associated with organ failure as defined by Sequential Organ Failure Assessment (SOFA) score for adult inpatients before and during the SARS-CoV-2 pandemic. Methods: A retrospective cohort of 17,722 unique patients age ≥18 years and their 20,675 admissions to 3 hospitals within the Montefiore Health System from 1 February 2020 through 31 May 2020 was constructed from the electronic health record. The cohort was stratified into two groups based on admission date with the cutoff being on or after 17 March 2020, when the confirmed index case of SARS-CoV-2 was admitted. Sequential Organ Failure Assessment (SOFA) scores were computed every 2 hours for each patient starting at admission using an automated SOFA calculator to produce a SOFA score composed of cardiovascular, coagulation, liver, renal, and respiratory components. The neurologic component was not computed due to sparsity of Glasgow Coma Scale data captured electronically. Results: A total of 1,789,930 SOFA scores were computed for the 20,675 admissions. Testing for SARS-CoV-2 occurred more during the pandemic (87.6% vs. 1.7%), with 48.4% of pandemic admissions testing positive. There was a significant increase in ICU admissions, usage of invasive mechanical ventilation, ICU and hospital length of stay, and mortality during the pandemic as compared to before (Table 1). Renal failure was the most common organ failure on presentation for both periods, but the most common organ failure during hospitalization was respiratory, which increased 53% during the pandemic. The burden of organ failure was higher during the pandemic, with a significant increase in multiorgan failure as indicated by the number of patients with maximum SOFA scores ≥ 6 as compared to before the pandemic. Conclusions: Before and during the SARS-CoV-2 pandemic, respiratory and renal systems were the most common organ systems to fail. There was a marked increase in the burden of multiorgan failure during the pandemic leading to increased ICU admissions, invasive mechanical ventilation, hospital length of stay, and mortality.