In-hospital mortality in patients admitted to Australian intensive care units with COVID-19 between 2020 and 2024

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2025-03-01 DOI:10.1016/j.ccrj.2024.11.003

Matthew T. Donnan MBBS , Peinan Zhao PhD , Allen C. Cheng MBBS PhD , Aaliya Ibrahim MClinEpid , Annamaria Palermo RN, BA , Benjamin Reddi FCICM PhD , Claire Reynolds MNurs , Craig French MBBS , Edward Litton MBChB PhD , Hannah Rotherham MBBS , Husna Begum PhD , Jamie Cooper MD MBBS , Jodi Dumbrell MPH , Lewis Campbell FCICM MSc. , Mark Plummer PhD , Mahesh Ramanan FCICM MMed , Patricia Alliegro MD , Richard E. McAllister RN, BN , Simon Erickson MBBS, CICM , Shweta Priyadarshini FCICM MBBS , Aidan Burrell MBBS PhD

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引用次数: 0

Abstract

Objective

To describe and compare the demographics, management, and outcomes for patients with COVID-19 admitted to intensive care units (ICUs) in Australia across the various waves of the COVID pandemic.

Design, setting, and participants

People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.

Main outcome measures

Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.

Results

From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The Wild Type wave included 518 (5.1%) patients, the Delta wave 2467 (24.3%) patients, and the Omicron wave 7186 (70.7%) patients. The median (IQR) age was 61 (49–70) years, 54 (41–66) years, and 65 (45–75) years, respectively (P < 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the Omicron subvariant waves (range 60.0%–71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P < 0.001). Use of extracorporeal membrane oxygenation was highest during the Delta wave (3.6%, 83 patients, median duration 18 days [IQR 9.8–35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the Delta (adjusted HR 1.80, 95% CI: 1.38–2.35, p < 0.001) and Omicron (adjusted HR 1.88, 95% CI: 1.46–2.42, p < 0.001) waves when compared to the Wild Type wave.

Conclusion

COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the Omicron wave demonstrated the highest in-hospital mortality.

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2020年至2024年期间澳大利亚重症监护病房收治的COVID-19患者的住院死亡率

目的描述和比较澳大利亚在不同的COVID-19大流行期间入住重症监护病房（icu）的COVID-19患者的人口统计学、管理和结局。设计、环境和参与者：在2020年2月至2024年5月期间，在澳大利亚严重急性呼吸道感染短期发病率研究（SPRINT-SARI）研究中，年龄≥16岁且确诊为COVID-19的患者入住ICU。主要结局指标：住院死亡率。次要结局：ICU死亡率；ICU和住院时间；支持性和疾病特异性治疗。结果2020年2月27日至2024年5月18日，72例icu确诊病例10171例。野性波518例（5.1%），德尔塔波2467例（24.3%），欧米克隆波7186例（70.7%）。中位（IQR）年龄分别为61（49 ~ 70）岁、54（41 ~ 66）岁和65（45 ~ 75）岁(P <；0.001)。接种疫苗的病例比例在连续波中增加（1% vs 23.9% vs 65.1%），但在Omicron亚变异波中稳定（60.0%-71.9%）。有创机械通气的使用在连续波中下降(52.5% vs 43.6% vs 31.7%, P <；0.001)。体外膜氧合的使用率在δ波期间最高（3.6%，83例，中位持续时间18天[IQR 9.8-35]）。多变量分析显示，入院患者住院死亡风险增加(调整HR 1.80, 95% CI: 1.38-2.35, p <；0.001)和Omicron(校正后危险度1.88,95% CI: 1.46-2.42, p <；0.001)波与野生型波相比。结论covid -19在ICU住院患者中仍有显著的发病率和死亡率。尽管对ICU水平支持的需求减少，但在欧米克隆波期间入院的患者显示出最高的住院死亡率。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.