EXPRESS: Epidemiology and Outcomes of Previously Healthy Critically Ill Patients with COVID-19: a Population-Based Cohort

Comorbid conditions represent a major risk for severe illness among persons with COVID-19. Previously healthy people with COVID-19 can also develop severe illness, but are expected to have better outcomes than those with comorbid conditions. Nevertheless, recent data suggest that the former may have, counterintuitively, higher risk of death among those with non-COVID sepsis. However, the epidemiology and outcomes of previously healthy people among critically ill patients with COVID-19 are unknown. We used statewide data to identify ICU admissions aged ≥18 years in Texas with COVID-19 in 2020. Multilevel logistic regression was used to estimate the association of comorbid state with short-term mortality (defined as in-hospital mortality or discharge to hospice) overall and with higher illness severity among ICU admissions. Among 52,776 ICU admissions with COVID-19, 6,373 (12.1%) were previously healthy. Short-term mortality among previously healthy ICU admissions and those with comorbidities was 16.9% vs 34.6%. On adjusted analyses, the odds of short-term mortality were lower among the previously healthy compared to those with comorbidities overall (adjusted odds ratio [aOR] 0.84 [95% CI 0.73-0.98]), but did not differ among those with ≥3 organ dysfunctions (aOR 1.11 [95% CI 0.84-1.46]) and the mechanically ventilated (aOR 0.87 [95% CI 0.68-1.12]), while being higher among those with do-not-resuscitate status (aOR 1.40 [95% CI 1.04-1.89]). Over 1 in 8 ICU admissions with COVID-19 were previously healthy. Although being previously healthy was associated with lower risk of death compared to those with comorbidities overall, it had no prognostic advantage among the more severely ill.