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

Abhimanyu Chandel, MD; Sahar Leazer, MD; Karl C. Alcover, PhD; Josiah Farley, BS; Joshua Berk, BA; Christopher Jayne, BS; Ryan Mcnutt, BS; Meredith Olsen, MD; Rhonda Allard, MLIS; Jiahong Yang, BS; Caitlyn Johnson, BS; Ananya Tripathi, BS; Maria Rechtin, MD; Mathew Leon, MMSc; Mathias Williams, MD; Phorum Sheth, MS; Kyle Messer, DO; Kevin K. Chung, MD; Jacob Collen, MD

doi:10.1097/CCE.0000000000000876

Critical Care Explorations (Mar 2023)

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

Abhimanyu Chandel, MD,
Sahar Leazer, MD,
Karl C. Alcover, PhD,
Josiah Farley, BS,
Joshua Berk, BA,
Christopher Jayne, BS,
Ryan Mcnutt, BS,
Meredith Olsen, MD,
Rhonda Allard, MLIS,
Jiahong Yang, BS,
Caitlyn Johnson, BS,
Ananya Tripathi, BS,
Maria Rechtin, MD,
Mathew Leon, MMSc,
Mathias Williams, MD,
Phorum Sheth, MS,
Kyle Messer, DO,
Kevin K. Chung, MD,
Jacob Collen, MD

Affiliations

Abhimanyu Chandel, MD: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Sahar Leazer, MD: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Karl C. Alcover, PhD: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Josiah Farley, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Joshua Berk, BA: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Christopher Jayne, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Ryan Mcnutt, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Meredith Olsen, MD: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Rhonda Allard, MLIS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Jiahong Yang, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Caitlyn Johnson, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Ananya Tripathi, BS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Maria Rechtin, MD: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Mathew Leon, MMSc: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Mathias Williams, MD: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Phorum Sheth, MS: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Kyle Messer, DO: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Kevin K. Chung, MD: 2 Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
Jacob Collen, MD: 1 Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.

DOI: https://doi.org/10.1097/CCE.0000000000000876
Journal volume & issue: Vol. 5, no. 3
p. e0876

Abstract

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OBJECTIVES:. To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES:. A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION:. Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION:. Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS:. One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0–27.8%), 37.3% (95% CI: 34.6–40.1%), 51.6% (95% CI: 46.1–57.0%), 66.1% (95% CI: 59.7–72.2%), and 58.0% (95% CI: 46.9–68.9%), respectively. MV (52.7%, 95% CI: 47.5–58.0% vs 31.3%, 95% CI: 16.1–48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1–73.0% vs 50.3%, 95% CI: 42.4–58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS:. We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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