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Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

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dc.contributor.authorGreco, Massimiliano
dc.contributor.authorDe Corte, Thomas
dc.contributor.authorErcole, Ari
dc.contributor.authorAntonelli, Massimo
dc.contributor.authorAzoulay, Elie
dc.contributor.authorCiterio, Giuseppe
dc.contributor.authorMorris, Andy Conway
dc.contributor.authorDe Pascale, Gennaro
dc.contributor.authorDuska, Frantisek
dc.contributor.authorElbers, Paul
dc.contributor.authorEinav, Sharon
dc.contributor.authorForni, Lui
dc.contributor.authorGalarza, Laura
dc.contributor.authorGirbes, Armand R. J.
dc.contributor.authorGrasselli, Giacomo
dc.contributor.authorGusarov, Vitaly
dc.contributor.authorJubb, Alasdair
dc.contributor.authorKesecioglu, Jozef
dc.contributor.authorLavinio, Andrea
dc.contributor.authorDelgado, Maria Cruz Martin
dc.contributor.authorMellinghoff, Johannes
dc.contributor.authorMyatra, Sheila Nainan
dc.contributor.authorOstermann, Marlies
dc.contributor.authorPellegrini, Mariangela
dc.contributor.authorPovoa, Pedro
dc.contributor.authorSchaller, Stefan J.
dc.contributor.authorTeboul, Jean-Louis
dc.contributor.authorWong, Adrian
dc.contributor.authorDe Waele, Jan J.
dc.contributor.authorCecconi, Maurizio
dc.contributor.orcidGreco, Massimiliano [0000-0003-1003-4637]
dc.contributor.orcidDe Corte, Thomas [0000-0001-5011-6640]
dc.contributor.orcidErcole, Ari [0000-0001-8350-8093]
dc.contributor.orcidAntonelli, Massimo [0000-0003-3007-1670]
dc.contributor.orcidAzoulay, Elie [0000-0002-8162-1508]
dc.contributor.orcidCiterio, Giuseppe [0000-0002-5374-3161]
dc.contributor.orcidMorris, Andy Conway [0000-0002-3211-3216]
dc.contributor.orcidDe Pascale, Gennaro [0000-0002-8255-0676]
dc.contributor.orcidDuska, Frantisek [0000-0003-1559-4078]
dc.contributor.orcidElbers, Paul [0000-0003-0447-6893]
dc.contributor.orcidEinav, Sharon [0000-0001-8963-9633]
dc.contributor.orcidForni, Lui [0000-0002-0617-5309]
dc.contributor.orcidGalarza, Laura [0000-0002-4658-748X]
dc.contributor.orcidGirbes, Armand R. J. [0000-0002-0711-0494]
dc.contributor.orcidGrasselli, Giacomo [0000-0002-1735-1400]
dc.contributor.orcidGusarov, Vitaly [0000-0002-2900-1459]
dc.contributor.orcidJubb, Alasdair [0000-0001-5593-866X]
dc.contributor.orcidKesecioglu, Jozef [0000-0002-3007-8445]
dc.contributor.orcidLavinio, Andrea [0000-0002-8832-918X]
dc.contributor.orcidDelgado, Maria Cruz Martin [0000-0002-7468-4594]
dc.contributor.orcidMellinghoff, Johannes [0000-0002-5455-8953]
dc.contributor.orcidMyatra, Sheila Nainan [0000-0001-6761-163X]
dc.contributor.orcidOstermann, Marlies [0000-0001-9500-9080]
dc.contributor.orcidPellegrini, Mariangela [0000-0001-5668-7399]
dc.contributor.orcidPovoa, Pedro [0000-0002-7069-7304]
dc.contributor.orcidSchaller, Stefan J. [0000-0002-6683-9584]
dc.contributor.orcidTeboul, Jean-Louis [0000-0002-5748-7820]
dc.contributor.orcidWong, Adrian [0000-0003-4968-7328]
dc.contributor.orcidDe Waele, Jan J. [0000-0003-1017-9748]
dc.contributor.orcidCecconi, Maurizio [0000-0002-4376-6538]
dc.date.accessioned2022-06-30T15:00:56Z
dc.date.available2022-06-30T15:00:56Z
dc.date.issued2022-05-21
dc.date.submitted2022-02-23
dc.date.updated2022-06-30T15:00:56Z
dc.description.abstractAbstract: Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.
dc.identifier.doi10.17863/CAM.86050
dc.identifier.eissn1432-1238
dc.identifier.issn0342-4642
dc.identifier.others00134-022-06705-1
dc.identifier.other6705
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338639
dc.languageen
dc.publisherSpringer Berlin Heidelberg
dc.subjectOriginal
dc.subjectCOVID-19
dc.subjectSARS-CoV-2
dc.subjectPneumonia
dc.subjectCritical care
dc.subjectSurge capacity
dc.titleClinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
dc.typeArticle
dcterms.dateAccepted2022-04-13
prism.endingPage705
prism.issueIdentifier6
prism.publicationNameIntensive Care Medicine
prism.startingPage690
prism.volume48
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1007/s00134-022-06705-1

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