Skip to main content
Erschienen in: Critical Care 1/2020

Open Access 05.06.2020 | COVID-19 | Letter

Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature

verfasst von: Pipetius Quah, Andrew Li, Jason Phua

Erschienen in: Critical Care | Ausgabe 1/2020

Hinweise

Supplementary information

Supplementary information accompanies this paper at https://​doi.​org/​10.​1186/​s13054-020-03006-1.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The understanding of outcomes in the intensive care unit (ICU) for the coronavirus disease 2019 (COVID-19) remains poor. Studies have reported close to 100% mortality amongst patients requiring mechanical ventilation [1], and this together with the hypothesis that COVID-19 may not cause classic acute respiratory distress syndrome (ARDS) has led to concerns regarding the use of mechanical ventilation [2, 3]. We thus aimed to review the outcomes of ICU patients with COVID-19 from the existing literature.
We searched PubMed for studies published between Dec 1, 2019, and May 8, 2020, with at least ten ICU patients with COVID-19 and reported ICU mortality data. We excluded studies that had duplicate patients from other reports, did not provide data on ICU survival, enrolled only decedents, and excluded patients who were still hospitalised (Fig. 1 and Electronic Supplementary Material).
Several lessons can be surmised from Table 1, which outlines the 15 included studies conducted largely in countries worst hit by the pandemic. First, 56.1% of patients were still in the ICU at the time of study publication, and attempts to calculate mortality based on a sample of only deceased or discharged patients risk painting a skewed picture of reality [4]. Second, with the prior limitation in mind, the overall ICU mortality rate was 25.7%. In China, with 14.1% of patients still in the ICU, the mortality rate was 37.7%. These figures are not higher than the mortality rates of 35 to 45% seen in ARDS. Third, 29% of the ICU patients who died in the Chinese studies did not receive mechanical ventilation, and where systems experienced a surge of critically ill patients, up to 53.2% of patients who required ICU care were unable to receive it because of resource constraints [5]. In New York, 262 deaths occurred in hospital wards and outside the ICU, compared to 291 deaths in the ICU [4]. We hypothesise that rationing of ventilators and ICU beds in overwhelmed health systems may have resulted in attempts at postponing intubation, with a significant minority of patients received high-flow nasal cannula (13.7%) and noninvasive ventilation (11.3%) based on available data, despite uncertainty surrounding their roles.
Table 1
Respiratory support and outcomes for intensive care unit patients
Study
ICU sample size
Respiratory support
ICU outcomes
HFNC
NIV
IMV
IMV deaths
Deaths
Still in ICU
Discharged from ICUs
China
517
81 (15.7%)
118 (22.8%)
183 (35.4%)
132/167 (79.0%)
195 (37.7%)
73 (14.1%)
249 (48.2%)
 Yang, Wuhan
52
33 (63.5%)
29 (55.8%)
22 (42.3%)
19 (86.4%)
32 (61.5%)
12 (23.1%)
8 (15.4%)
 Wang, Wuhan
36
4 (11.1%)
15 (41.7%)
17 (47.2%)
6 (35.3%)
6 (16.7%)
11 (30.6%)
19 (52.8%)
 Zhang, Wuhan
44
0 (0%)
27 (61.4%)
16 (36.4%)
NA
9 (20.5%)
12 (27.3%)
23 (52.3%)
 Wang, Wuhan
344
35 (10.2%)
34 (9.9%)
100 (29.1%)
97 (97.0%)
133 (38.7%)
26 (7.6%)
185 (53.8%)
 Zhang, Wuhan
20
0
0
20 (100%)
7 (35.0%)
12 (60%)
7 (35.0%)
1 (5.0%)
 Zhou, Jiangsu
21
9 (42.9%)
13 (61.9%)
8 (38.1%)
3 (37.5%)
3 (14.3%)
5 (23.8%)
13 (61.9%)
Italy
1591
NA
137 (8.6%)
1150 (72.3%)
405/1150 (35.2%)
405 (25.6%)
920 (58.2%)
256 (16.2%)
 Grasselli, Lombardy
1591
NA
137 (8.6%)
1150 (72.3%)
405 (35.2)
405 (25.6%)*
920 (58.2%)*
256 (16.2%)*
USA
1392
11 (0.8%)
4 (0.3%)
1250 (89.8%)
305/1235 (24.7%)
328 (23.6%)
921 (66.2%)
143 (10.3%)
 Arentz, Washington
21
1 (4.8%)
4 (19.0%)
15 (71.4%)
NA
14 (66.7%)
5 (23.8%)
2 (9.5%)
 Bhatraju, Washington
24
10 (41.7%)
0 (0%)
18 (75.0%)
12 (66.7%)
12 (50.0%)
3 (12.5%)
9 (37.5%)
 Richardson, New York
1281
NA
NA
1151 (89.9%)
282 (24.5%)
291 (22.7%)
908 (70.9%)
82 (6.4%)
 Ziehr, Boston
66
0
0
66 (100%)
11 (16.7%)
11 (16.7%)
5 (7.6%)
50 (75.8%)
Spain
48
3 (6.3%)
0 (0%)
45 (93.8%)
14/45 (31.1%)
14 (29.2%)
21 (43.8%)
13 (27.1%)
 Barrasa, Vitoria
48
3 (6.3%)
0 (0%)
45 (93.8%)
14 (31.1%)
14 (29.2%)
21 (43.8%)
13 (27.1%)
Denmark
17
0
0
17 (100%)
7 /17 (41.2%)
7 (41.2%)
6 (35.3%)
4 (23.5%)
 Pedersen, Zealand
17
0
0
17 (100%)
7 (41.2%)
7 (41.2%)
6 (35.3%)
4 (23.5%)
Germany
37
NA
NA
NA
NA
9 (24.3%)
21 (56.8%)
7 (18.9%)
 Rieg, Freiburg
37
NA
NA
NA
NA
9 (24.3%)
21 (56.8%)
7 (18.9%)
UK
196
NA
NA
132 (66.3%)
NA
16 (8.0%)
163 (81.9%)
17 (8.5%)
 Mahase, UK
196
NA
NA
132 (66.3%)
NA
16 (8.0%)
163 (81.9%)
17 (8.5%)
Total
3798
95/693 (13.7%)
259/2284 (11.3%)
2645/3761 (70.3%)
863/2482 (34.8%)
974/3788* (25.7%)
2125/3788* (56.1%)
689/3788* (18.2%)
Data are presented as n (%). ICU intensive care unit, HFNC high-flow nasal cannula, NIV noninvasive ventilation, IMV invasive mechanical ventilation, NA data not available. *Data on disposition available for 1581 out of 1591 patients in the study by Grasselli et al., hence the denominator for ICU outcomes is 3788 rather than 3798
We conclude that while there is a need for further studies which capture patients’ final dispositions, the current preliminary data does not suggest unusually high ICU mortality rates for COVID-19. The poor outcomes seen in various studies may be related to rationing of resources in overwhelmed ICUs.

Supplementary information

Supplementary information accompanies this paper at https://​doi.​org/​10.​1186/​s13054-020-03006-1.

Acknowledgements

Not applicable.
No ethics approval and no patient consent were required for this study.
Not applicable.

Competing interests

All authors declare no competing interests.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Literatur
4.
Zurück zum Zitat Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, the Northwell C-RC, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020. https://doi.org/10.1001/jama.2020.6775. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, the Northwell C-RC, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020. https://​doi.​org/​10.​1001/​jama.​2020.​6775.
Metadaten
Titel
Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature
verfasst von
Pipetius Quah
Andrew Li
Jason Phua
Publikationsdatum
05.06.2020
Verlag
BioMed Central
Schlagwort
COVID-19
Erschienen in
Critical Care / Ausgabe 1/2020
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03006-1

Weitere Artikel der Ausgabe 1/2020

Critical Care 1/2020 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.