Outcomes from intensive care in patients with COVID‐19: a systematic review and meta‐analysis of observational studies

Abstract

Summary The emergence of coronavirus disease 2019 (COVID‐19) has led to high demand for intensive care services worldwide. However, the mortality of patients admitted to the intensive care unit (ICU) with COVID‐19 is unclear. Here, we perform a systematic review and meta‐analysis, in line with PRISMA guidelines, to assess the reported ICU mortality for patients with confirmed COVID‐19. We searched MEDLINE, EMBASE, PubMed and Cochrane databases up to 31 May 2020 for studies reporting ICU mortality for adult patients admitted with COVID‐19. The primary outcome measure was death in intensive care as a proportion of completed ICU admissions, either through discharge from the ICU or death. The definition thus did not include patients still alive on ICU. Twenty‐four observational studies including 10,150 patients were identified from centres across Asia, Europe and North America. In‐ICU mortality in reported studies ranged from 0 to 84.6%. Seven studies reported outcome data for all patients. In the remaining studies, the proportion of patients discharged from ICU at the point of reporting varied from 24.5 to 97.2%. In patients with completed ICU admissions with COVID‐19 infection, combined ICU mortality (95%CI) was 41.6% (34.0–49.7%), I2 = 93.2%). Sub‐group analysis by continent showed that mortality is broadly consistent across the globe. As the pandemic has progressed, the reported mortality rates have fallen from above 50% to close to 40%. The in‐ICU mortality from COVID‐19 is higher than usually seen in ICU admissions with other viral pneumonias. Importantly, the mortality from completed episodes of ICU differs considerably from the crude mortality rates in some early reports.

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

“…Taken together, our results are consistent with the recent nding by Armstrong et alof improved COVID-19 ICU outcome over time, which was attributed to increased ICU experience, and evolving admission criteria, treatments, and demographics [40]. We additionally hypothesize that aimprovements in reported mortalities over time and regions may arise as healthcare systems become less overwhelmed, and as more recent studies account for more complete patient outcomes.…”

“…Our pooled ICU best case mortality rate of 28.3% (95% CI 0.27 to 0.32) amongst COVID-19 patients is lower than earlier reports from Wuhan's 78% [20] and Seattle's 85% [8], but in line with the more recent report of 31% from Atlanta [10], as well as 25.7% and 41.6% reported in reviews by Quah et al [39] and Armstrong et al [40] respectively.…”

“…This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU cases and outcomes to date to our knowledge. Many reviews explored COVID-19 prognosis, with some reporting generally on all [36] or hospitalized cases [37], or from a certain region [38], or focused on speci c aspects such as mortality [39] or outcomes [40], with only one systematic review speci cally addressing IMV mortality [41]. Here we attempt to provide a comprehensive assessment of ICU-admitted COVID-19 patient characteristics, regional discrepancies, as well as overall ICU and IMV speci c outcomes and their associated factors.…”

Timing of Intubation and In-Hospital Mortality in Patients With Coronavirus Disease 2019

“…Reports from hospitals caring for patients during the initial outbreak in China indicated that at least 80% of patients with COVID-19 requiring mechanical ventilation died ( 1 , 3 ). A recent meta-analysis, however, found that the mortality rate for ICU patients has fallen to approximately 40% as the pandemic has progressed, suggesting improvements in treatments and system resources ( 4 ).…”

Effectiveness of Mid-Regional Pro-Adrenomedullin (MR-proADM) as Prognostic Marker in COVID-19 Critically Ill Patients: an Observational Prospective Study

“…Concerning mortality, our data are slightly higher than the values reported in the literature (54.4%). In fact, in a recent metanalysis on 24 observational studies, in patients with completed ICU admissions with COVID-19 infection, combined ICU mortality (95%CI) was 41.6% (34.0-49.7%) [48]. To note, the in-ICU mortality from COVID-19 is far higher than usually seen in ICU admissions with other viral pneumonias.…”