Outcomes Associated With Intensive Care and Organ Support Among Patients With COVID-19: A Systematic Review and Meta-Analysis

Abstract

Background Accurate accounting of coronavirus disease 2019 (COVID-19) critical care outcomes has important implications for health care delivery. Research Question We aimed to determine critical care and organ support outcomes of intensive care unit (ICU) COVID-19 patients and whether they varied depending on the completeness of study follow-up or admission time period. Study Design and Methods We conducted a systematic review and meta-analysis of reports describing ICU, mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) mortality. A search was conducted using PubMed, Embase, and Cochrane databases. We included English language observational studies of COVID-19 patients, reporting ICU admission, MV, and ICU case fatality, published from December 1, 2019 to December 31, 2020. We excluded reports of less than 5 ICU patients and pediatric populations. Study characteristics, patient demographics, and outcomes were extracted from each article. Subgroup meta-analyses were performed based on the admission end date and the completeness of data. Results Of 6,778 generated articles, 145 were retained for inclusion (n = 60,357 patients). Case fatality rates across all studies were 34.0% (95% CI = 30.7%, 37.5%, P < 0.001) for ICU deaths, 47.9% (95% CI = 41.6%, 54.2%, P < 0.001) for MV deaths, 58.7% (95% CI = 50.0%, 67.2%, P < 0.001) for RRT deaths, and 43.3% (95% CI = 31.4%, 55.4%, P < 0.001) for extracorporeal membrane oxygenation deaths. There was no statistically significant difference in ICU and organ support outcomes between studies with complete follow-up versus studies without complete follow-up. Case fatality rates for ICU, MV, and RRT deaths were significantly higher in studies with patients admitted before April 31st 2020. Interpretation Coronavirus disease 2019 critical care outcomes have significantly improved since the start of the pandemic. Intensive care unit outcomes should be evaluated contextually (study quality, data completeness, and time) for the most accurate reporting and to effectively guide mortality predictions.

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…Our group previously reported a systematic review presenting data related to critical care outcomes in patients with COVID-19 (166). This review was limited by its inclusion of low-quality small sample studies and the restriction to studies published before the start of 2021.…”

Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study

“…38 The mortality rate from COVID-19 in our study population aligns with the reported rates in the literature, ranging from 25% to 55% for these patients. 41,42 Male sex, dyslipidemia, hyperkalemia, kidney injury, and orotracheal intubation were identified as factors related to mortality. Variables such as creatinine, bilirubin, PaCO 2 , and DEOx were independently associated with MODS, which are commonly associated with poorer outcomes in critically ill patients.…”

Assessment of the ABC2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores

“…Although studies highlight the substantial impact of vaccination on the trajectory of the pandemic, with up to 90% protection against COVID-19-associated invasive mechanical ventilation (IMV) and death among adults (2,3). It is estimated that the mortality rate associated with IMV continues overcoming 30% (4). A recent systematic review and meta-analysis found a 43% (95% CI 0.29-0.58) pooled IMV mortality rate (1).…”

“…It predicts in-hospital mortality in patients with COVID-19 using easily accessible variables on admission: Age, BUN (blood urea nitrogen), Comorbidities, C-reactive protein, SpO 2 /FiO 2 ratio, Platelet count, and Heart rate. The score ranges from 0 to 20, with the following risk groups: low (0-1), intermediate (2)(3)(4), high (5)(6)(7)(8), and very high (≥9). It is freely available as an online risk calculator.…”