Improved 60‐day survival but impaired general health in Swedish ICU‐COVID patients: An ambidirectional population‐based study

Forsberg, Gustaf; Berg, Sören; Divanoglou, Anestis; Levi, Richard; Ekqvist, David; Balkhed, Åse Östholm; Niward, Katarina

doi:10.1111/aas.14054

Cited by 4 publications

(1 citation statement)

References 43 publications

(73 reference statements)

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“…As our understanding of the disease, progressed subsequent studies were conducted to investigate long-term survival rates and outcomes, aiming to gain a deeper understanding of prognosis and the effectiveness of various treatment approaches 26 , 27 . Many of these later studies with extended observation periods, however, were observational 26 – 28 , like the present real-world data (RWD) study, which complemented the findings of randomized controlled trials (RCTs).…”

Section: Discussionmentioning

confidence: 52%

In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study

Angermair,

Hardenberg,

Rubarth

et al. 2024

Sci Rep

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The COVID-19 pandemic has posed a major challenge to healthcare systems globally. Millions of people have been infected, and millions of deaths have been reported worldwide. Glucocorticoids have attracted worldwide attention for their potential efficacy in the treatment of COVID-19. Various glucocorticoids with different dosages and treatment durations have been studied in patients with different severities, with a suitable dosage and treatment duration not yet defined. This study aimed to investigate whether in-hospital survival differs between critically ill patients treated with low-dose glucocorticoids, high-dose glucocorticoids or no glucocorticoids. All critically ill patients admitted to the intensive care unit of the Charité Hospital—Universitätsmedizin Berlin between February 2020 and December 2021 with COVID-19 pneumonia receiving supplemental oxygen were eligible to participate in this multicenter real-world data study. Patients were retrospectively assigned to one of three groups: the high corticosteroid dose (HighC) group (receiving 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), the low corticosteroid dose (LowC) group (receiving less than 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), or the no corticosteroid (NoC) group. Overall survival and risk effects were compared among groups within the total observation period, as well as at 35 days after the onset of COVID-19 symptoms. Adjusted multivariable Cox proportional hazard regression analysis was performed to compare the risk of death between the treatment groups. Out of 1561 critically ill COVID-19 patients, 1014 were included in the baseline analysis. In the survival study, 1009 patients were assigned to the NoC (n = 346), HighC (n = 552), or LowC group (n = 111). The baseline characteristics were balanced between groups, except for age, BMI, APACHE II score, SOFA and SAPS II. While the 35-day survival did not show any differences, a landmark analysis of the patients surviving beyond 35 days revealed differences between groups. The restricted mean survival time was 112 days in the LowC group [95% CI: 97 – 128], 133 days in the HighC group [95% CI: 124 – 141] and 144 days in the NoC group [95% CI: 121 – 167]. The multivariable-adjusted Cox proportional hazard analysis indicated that, regardless of age, sex, health status or invasive oxygenation, a low-dose treatment increased the hazard of death of critically ill COVID-19 patients by a factor of 2.09 ([95% CI: 0.99, 4.4], p = 0.05) and a high-dose corticosteroid treatment increased the risk by a factor of 1.07 ([95% CI: 0.53, 2.15], p = 0.85) compared to no treatment with glucocorticoids. The analysis reveals that corticosteroid treatment does not influence the survival of critically ill COVID-19 patients in the intensive care unit within 35 days. Our evaluations further suggest that regardless of ventilation status, the decision-making process for administering corticosteroid therapy should account for the individual severity of the illness.

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Section: Discussionmentioning

confidence: 52%

In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study

Angermair,

Hardenberg,

Rubarth

et al. 2024

Sci Rep

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Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study

Wahlgren

Forsberg

Divanoglou

et al. 2023

The Lancet Regional Health - Europe

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Improved 60‐day survival but impaired general health in Swedish ICU‐COVID patients: An ambidirectional population‐based study

Forsberg

Berg

Divanoglou

et al. 2022

Acta Anaesthesiol Scand

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Background: Survival among critically ill COVID-19 patients varies between countries and time periods. Mortality rates up to 60% have been reported in intensive care units (ICUs). Standard-of-care has evolved throughout the pandemic. The purpose of the study was to explore management and mortality of COVID-19 ICU-patients during the first pandemic wave and assess their post-ICU health status. Methods: We conducted an exploratory observational ambidirectional populationbased study of ICU-patients with COVID-19 in a Swedish county during 1 March-30 June 2020. Primary outcome was 60-day mortality with secondary outcomes including treatments, complications, self-reported general health and dyspnoea post-discharge. Patients were consecutively divided into equal tertiles with cut-offs on April 4 and April 20, 2020, to analyse time trends.Results: One hundred patients, median age was 63 years, were included, and 60-day mortality rate was 22%. Ninety-one percent had moderate/severe ARDS and 88% required mechanical ventilation. In the first tertile of patients 60-day mortality was 33%, declining to 15% and 18% in the following two. This reduction paralleled increased use of thromboprophylaxis, less steep rise of treated ICU-patients per day and expanded ICU resources. Four months post-discharge, 63% of survivors reported self-assessed decline in general health retrospectively compared to prior COVID-19. Conclusions:In this cohort, the initial 60-day mortality quickly declined, despite continuous admittance of critically ill patients. This was parallel to adaptation to increased workload and more intense thromboembolic prophylaxis. A majority of survivors reported declined general health four months after discharge. Further studies on long-term health status of ICU-survivors are indicated.

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Improved 60‐day survival but impaired general health in Swedish ICU‐COVID patients: An ambidirectional population‐based study

Cited by 4 publications

References 43 publications

In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study

In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study

Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study

Improved 60‐day survival but impaired general health in Swedish ICU‐COVID patients: An ambidirectional population‐based study

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