Researchers Examine Death Risks for Coronavirus Patients in ICUs

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By Christopher Cheney

New research has linked several factors with risk of death in critically ill patients with coronavirus disease 2019 (COVID-19).

In the United States, the COVID-19 pandemic is developing into the most deadly infectious disease outbreak since the 1918 Spanish flu. As of July 21, more than 3,900,000 Americans had contracted the novel coronavirus and more than 143,0 had died, according to worldometer.

The new research, which was published by JAMA Internal Medicine, is based on data collected from more than 2,000 adults diagnosed with COVID-19 who were admitted to ICUs at 65 hospitals across the United States from March 4 to April 4.

The study includes several key data points:

  • 35.4% of the ICU patients died within 28 days
  • Older age (patients at least 80 years old vs. patients less than 40 years old) was associated with a high risk of death, odds ratio 11.15
  • Men had a relatively high risk of death compared to women, odds ratio 1.50
  • Higher body mass index (at least 40 vs. less than 25) was associated with a high risk of death, odds ratio 1.51
  • Coronary artery disease was associated with a high risk of death, odds ratio 1.47
  • Active cancer was associated with a high risk of death, odds ratio 2.15
  • Presence of hypoxemia was associated with a high risk of death, odds ratio 2.94
  • Liver dysfunction was associated with a high risk of death, odds ratio 2.61
  • Kidney dysfunction was associated with a high risk of death, odds ratio 2.43
  • The most common medications administered to the patients were hydroxychloroquine (79.5%), azithromycin (59.6%), and therapeutic anticoagulants (41.5%)
  • Hospitals with fewer ICU beds were associated with a higher risk of death

The researchers identified significant variation in the administration of medications and supportive therapies at the hospitals in the study. “Sources of this variation may include the limited high-quality evidence on which to base clinical practice, variation in hospital resources to implement personnel-intensive interventions (e.g., prone positioning), variation in the availability of certain medications (e.g., remdesivir), or unmeasured variation in patient and practitioner characteristics across centers,” the researchers wrote.

The factors associated with higher risk of death can help clinicians determine courses of treatment for the sickest COVID-19 patients, they wrote. “This study identified demographic, clinical, and hospital-level factors associated with death in critically ill patients with COVID-19 that may be used to facilitate the identification of medications and supportive therapies that can improve outcomes.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.