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COVID-19 Registry Reveals Factors Leading To Increased Mortality
Age, Need for Organ Support, Hospital of Admission Play Large Roles
By CHRISTINA FRANGOU
Hospitals around the world report wide variations in mortality rates for patients admitted with COVID-19, with a consistent pattern: Risk for mortality increases with age and need for organ support, according to results from a global registry.
In February 2020, the Society of Critical Care Medicine and the Critical Care Research Network launched VIRUS (Viral Infection and Respiratory Illness Universal Study) to track hospital care patterns in near real time. Since then, 298 hospitals in 26 countries have joined, with data collected on 64,182 hospital admissions and 12,130 ICU admissions.
This is one of the first large studies to evaluate outcomes among patients with COVID-19 according to a major prognostic factor: organ support required by patients.
The hospital where patients were admitted made a difference to their outcomes. The risk-adjusted mortality rates for 4,749 patients who received invasive mechanical ventilation (IMV) ranged from 27.7% to 77.9%; a patient presenting to a hospital with poorer outcomes had a 1.69 odds of dying compared with a similar patient at a hospital with lower mortality.
Amos Lal, MBBS, a critical care fellow at Mayo Clinic in Rochester, Minn., presented results at the 2021 Critical Care Congress Virtual Event. The paper was published in March in Critical Care Medicine (2021;49[3]:437-448).
Approximately 10% of the variation in mortality is explained by the hospitals of admission, Dr. Lal said.
“This presents an opportunity for quality improvement and for future studies to learn from practices at hospitals that achieved low adjusted mortality rates,” he said.
Many hospitals in the United States had lower mortality than other countries, but even within this country, mortality differed between hospitals. The effect of country was “a likely minor contributor” to mortality variation, he said.
Dr. Lal and his colleagues studied patients admitted with COVID-19 at participating hospitals between February and November 2020. At the time, the registry included data from 179 institutions and 49,058 patients. Of these, 20,608 patients had complete outcomes data and were included in the analysis.
Patients had a mean age of 60.5 years, 54.3% were men, and 50.4% of patients were white, 25.9% Black and 5.6% Hispanic; 85% had at least one comorbid condition and 42.4% required ICU admission.
Overall, 19% of patients died. Patients younger than 45 years of age who did not receive organ support therapies were the least likely to die, with a mortality rate of less than 1%. Patients with the highest risk for death were those older than 74 who received IMV, vasoactive drugs and renal replacement therapy (RRT). In this group, 78.3% of patients died.
At all ages, patients were more likely to die as they needed more organ support. Among patients placed on IMV alone, 40.8% died. Mortality rose to 71.6% for those who received IMV, vasoactive drugs and RRT.
Only 2% of patients in the registry received extracorporeal membrane oxygenation (ECMO). In this group, 35% died.
“Remarkably, the mortality for those critically ill patients receiving ECMO is lower than some of the other subgroups, which probably reflects the selection of patients most likely to benefit from ECMO,” said Greg Martin, MD, the president of SCCM and a professor of medicine at Emory University, in Atlanta.
Three-fourths of patients received no organ support. Of those who did, IMV was the most common method, used in 24.3%, either alone or in combination with other organ support therapies. Only 2.9% of patients (n=602) received vasoactive drugs and/or acute RRT without IMV.
The VIRUS registry helps researchers and clinicians get a better understanding of what people and hospitals around the world
—Greg Martin, MD
