APACHE-adjusted ICU Outcomes Have Returned to Pre-pandemic Values

During the COVID-19 pandemic, severity-adjustment systems lacked longitudinal data for the coronavirus and thus could not specify diagnosis-specific risk. Without risk adjustment for the patient’s diagnosis and presenting condition, outcomes such as morbidity, mortality, and length of stay become challenging to interpret. APACHE, which risk-adjusts for acute physiology, age, and chronic health, is a widely used ICU benchmarking tool, and participating institutions identified rising and concerning standardized mortality rates in 2020. Following up on previously reported results that severity-adjusted outcomes were worse than expected for patients with COVID-19 versus traditional viral pneumonia during the first two years of the pandemic, the authors now report data that suggest the COVID-19 mortality penalty versus other viral pneumonia lessened once the Omicron variant became the predominant pathogen in early 2022. They present implications for benchmarking hospital performance and public reporting.