Causes and Circumstances of Death among Patients Hospitalized with COVID-19: A Retrospective Cohort Study

Ketcham, Scott W.; Bolig, Thomas; Molling, Daniel; Sjoding, Michael W.; Flanders, Scott A.; Prescott, Hallie C.

doi:10.1513/annalsats.202011-1381rl

Cited by 31 publications

(32 citation statements)

References 9 publications

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“…Our investigation into the timing and causes of death in severe COVID-19 patients stands out, irrespective of previous studies in the same topic currently in the literature [ 4 , 5 ], due to the following distinct points. First, this is the first multi-center study, albeit in the same country.…”

Section: Discussionmentioning

confidence: 90%

“…Considering this, we reported the existence of MODS rather than septic shock to avoid the gathering of several different etiologies under the identity of septic shock. Moreover, studies reporting causes of death in patients with SARS-CoV-2 infection admitted to the ICU report either a striking 48% mortality rate [ 5 ] or no data regarding the in-ICU mortality rate [ 4 ], therefore limiting the external validity of these results.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to differences in patient characteristics at admission and heterogeneity in management, the absence of a description of cause of death limits their interpretation. Two recent single-center studies specifically reported the timing and causes of death in severe COVID-19 patients [ 4 , 5 ]. Despite reporting respiratory failure as the major cause of death, these two studies differ by reporting either organ failure or syndrome-based approaches, thereby limiting comparison.…”

Section: Introductionmentioning

confidence: 99%

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Timing and causes of death in severe COVID-19 patients

et al. 2021

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Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Timing and causes of death in severe COVID-19 patients

et al. 2021

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“…Interestingly, septic shock was present in 40.2% cases. However, septic shock was considered the primary cause of death only in 26.8% [ 38 ▪ ]. Gupta et al [ 32 ▪▪ ] analyzed the cause of death from 787 patients and found that 92.7% of them died from respiratory failure; however, almost 40% also had septic shock.…”

Section: Severity Of Sepsis In Coronavirus Disease 2019 Patientsmentioning

confidence: 99%

Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?

Ramos

Freitas

Machado

2021

Current Opinion in Critical Care

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Purpose of review To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates. Recent findings In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings. Patients with severe COVID-19 present a phenotype of multiorgan dysfunction that leads to death in an unacceptable high percentage of the patients, with wide variability around the world. Similarly to endemic sepsis, the mortality of COVID-19 critically ill patients is higher in low-income and middle-income countries as compared with high-income countries. Disparities, including hospital strain, resources limitations, higher incidence of healthcare-associated infections (HAI), and staffing issues could in part explain this variability. Summary The high mortality rates of critically ill patients with severe COVID-19 disease are not only related to the severity of patient disease but also to modifiable factors, such as the ICU strain, HAI incidence, and organizational aspects. Therefore, HAI prevention and the delivery of best evidence-based care for these patients to avoid additional damage is important. Quality improvement interventions might help in improving outcomes mainly in resource-limited settings.

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“…As of April 4, 2020, 1,151 (20.2%) patients requiring mechanical ventilation, 38 (3.3%) were discharged alive, 282 (24.5%) died while admitted, and 831 (72.2%) remained in the hospital 25 . Pulmonary dysfunction was a key driver of mortality, accounting for 56.1% of COVID-related hospital deaths, compared to just 21.6% of deaths in recent cohorts of decedents with acute hypoxemia respiratory failure 28 .…”

Section: Introductionmentioning

confidence: 99%