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14.04.2021 | COVID-19 | Original Zur Zeit gratis

Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months

verfasst von: Pedro Kurtz, Leonardo S. L. Bastos, Leila F. Dantas, Fernando G. Zampieri, Marcio Soares, Silvio Hamacher, Jorge I. F. Salluh, Fernando A. Bozza

Erschienen in: Intensive Care Medicine | Ausgabe 5/2021

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Abstract

Purpose

Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients.

Methods

A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27^th and October 28^th, 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting.

Results

Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54–0.65], p < 0.001).

Conclusion

Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data.

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Titel: Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months
verfasst von: Pedro Kurtz
Leonardo S. L. Bastos
Leila F. Dantas
Fernando G. Zampieri
Marcio Soares
Silvio Hamacher
Jorge I. F. Salluh
Fernando A. Bozza
Publikationsdatum: 14.04.2021
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Intensive Care Medicine / Ausgabe 5/2021
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06388-0

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Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months