Post by Nadica (She/Her) on Aug 6, 2024 23:08:58 GMT
Outcomes for people admitted to Australian and New Zealand intensive care units with primary, exacerbating, or incidental SARS‐CoV‐2 infections, 2022–23: a retrospective analysis of ANZICS data - Published Aug 5, 2024
Abstract
Objectives: To compare in‐hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022–23 with coronavirus disease 2019 (COVID‐19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections, or without SAR‐CoV‐2 infections.
Study design: Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data.
Setting, participants: Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 – 30 June 2023.
Major outcome measures: The primary outcome was in‐hospital mortality, the secondary outcome ICU length of stay, each by SARS‐CoV‐2 infection attribution classification: primary COVID‐19; exacerbating SARS‐CoV‐2 infection (SARS‐CoV‐2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS‐CoV‐2 infections (SARS‐CoV‐2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS‐CoV‐2 infection.
Results: A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022–23; 2674 people (1.3%) had incidental SARS‐CoV‐2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID‐19. Unadjusted in‐hospital mortality for people with incidental SARS‐CoV‐2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID‐19 (830 deaths, 22.9%), but higher than for patients without SARS‐CoV‐2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS‐CoV‐2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10–1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22–1.48), or primary COVID‐19 (aOR, 2.54; 95% CI, 2.30–2.81) than for patients without SARS‐CoV‐2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4–4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2–1.5 hours) than for those without SARS‐CoV‐2 infections.
Conclusion: Risk‐adjusted in‐hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS‐CoV‐2 infections than for people who do not.
The known: Early in the COVID‐19 pandemic, outcomes for people admitted to hospital with other conditions were poorer if they had concomitant SARS‐CoV‐2 infections.
The new: During 2022–23, risk‐adjusted in‐hospital mortality was higher and median ICU length of stay longer for people admitted to intensive care in Australia or New Zealand with SARS‐CoV‐2 infections, even when the infection was not the primary or a contributing reason for the ICU admission.
The implications: Despite improved treatments and widespread vaccination in Australia and New Zealand, SARS‐CoV‐2 infections are still associated with poorer clinical outcomes for people admitted to ICUs.
Abstract
Objectives: To compare in‐hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022–23 with coronavirus disease 2019 (COVID‐19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections, or without SAR‐CoV‐2 infections.
Study design: Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data.
Setting, participants: Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 – 30 June 2023.
Major outcome measures: The primary outcome was in‐hospital mortality, the secondary outcome ICU length of stay, each by SARS‐CoV‐2 infection attribution classification: primary COVID‐19; exacerbating SARS‐CoV‐2 infection (SARS‐CoV‐2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS‐CoV‐2 infections (SARS‐CoV‐2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS‐CoV‐2 infection.
Results: A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022–23; 2674 people (1.3%) had incidental SARS‐CoV‐2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID‐19. Unadjusted in‐hospital mortality for people with incidental SARS‐CoV‐2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID‐19 (830 deaths, 22.9%), but higher than for patients without SARS‐CoV‐2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS‐CoV‐2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10–1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22–1.48), or primary COVID‐19 (aOR, 2.54; 95% CI, 2.30–2.81) than for patients without SARS‐CoV‐2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4–4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2–1.5 hours) than for those without SARS‐CoV‐2 infections.
Conclusion: Risk‐adjusted in‐hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS‐CoV‐2 infections than for people who do not.
The known: Early in the COVID‐19 pandemic, outcomes for people admitted to hospital with other conditions were poorer if they had concomitant SARS‐CoV‐2 infections.
The new: During 2022–23, risk‐adjusted in‐hospital mortality was higher and median ICU length of stay longer for people admitted to intensive care in Australia or New Zealand with SARS‐CoV‐2 infections, even when the infection was not the primary or a contributing reason for the ICU admission.
The implications: Despite improved treatments and widespread vaccination in Australia and New Zealand, SARS‐CoV‐2 infections are still associated with poorer clinical outcomes for people admitted to ICUs.