In a recent article published by the Society of Critical Care Anesthesiologists, Penn Anesthesiology and Critical Care physicians, Timothy Gaulton, MD, MSCE, and Meghan Lane-Fall, MD, MSHP, FCCM, noted that in the context of mechanical ventilation, an appreciation of hospital and critical care capacity, critical resource availability and time of death were key to understanding rates of mortality in critically ill patients with COVID-19.
Shortly after these observations appeared, the first report of the Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 (STOP-COVID) was published in JAMA Internal Medicine.
Co-authored by Penn nephrologist Amanda K. Leonberg-Yoo, MD, STOP-COVID is among the first large, geographically diverse examinations of the demographic, clinical, and hospital-level risk factors associated with death in critically ill patients with COVID-19.
A Study On Death in Critically Ill Patients with COVID-19
The principal investigator for STOP-COVID at Penn Medicine, Dr. Leonberg-Yoo, was joined by clinical epidemiologists Todd A. Miano, PharmD, MSCE, PhD, of Penn's Center for Real-World Effectiveness and Safety of Therapeutics (CREST), and Meaghan Roche, MD, and Charles Vasquez, MD, of the Perelman School of Medicine.
Outcomes
The primary outcome for STOP-COVID was death within 28 days of ICU admission. The study involved 2215 adults with laboratory-confirmed COVID-19 admitted to ICUs at 65 hospitals across the United States from March 4 to April 4, 2020.
Among the factors evaluated for a potential association with mortality were demographics, comorbidities, organ dysfunction, hospital characteristics (including number of beds and type of ICU), and inter-hospital variation in treatment and outcomes. Medications on entry to the ICU and after hospital admission were assessed, as were the onset of acute and secondary organ injury following ICU admission.
Of the 2,215 COVID patients who entered the ICU during the 30-day evaluation period, 784 patients (35.4 percent) died within 28 days of ICU admission. Another 824 (37.2 percent) were discharged alive from the hospital, and 607 (27.4 percent) remained hospitalized. Of the latter group, 91 patients would die beyond the 28-day parameter for the study, bringing the total death rate in the original population at the time of publication to 39.5 percent.
Prominent factors independently associated with higher risk of death in critically ill patients with COVID-19 included older age, male sex, obesity, coronary artery disease, active cancer, acute organ dysfunction (liver, kidney) and admission to a hospital with fewer ICU beds.
Leading causes of death included respiratory failure (92.7 percent), septic shock (39.7 percent), and kidney failure (37.6 percent), with many patients having multiple causes.
After an assessment of the study's strengths and weaknesses, the authors conclude that future research should examine patients with COVID-19 at greatest risk of adverse outcomes and seek to identify medications or supportive therapies that improve their outcomes.