In a new study, researchers found key factors that predict death in people with severe COVID-19.
The research was conducted by a team from Brigham and Women’s Hospital and elsewhere.
More than 3 million people in the United States have been infected with COVID-19 and more than 130,000 have died.
More people have died of COVID-19 in the U.S. than in any other country, but few studies offer national data on the factors that may contribute to outcomes for critically ill patients.
To address this gap, the team did the Study of the Treatment and Outcomes in critically ill Patients with COVID-19 (STOP-COVID), a multicenter cohort examination of the demographics, comorbidities, organ dysfunction, treatment, and outcomes of patients with COVID-19 admitted to intensive care units.
The team studied over 2,000 critically ill adults with COVID-19 and found that 35% of patients died in the 28 days after ICU admission.
They also found that treatment and outcomes varied greatly between hospitals.
Overall, 784 patients died within 28 days, with wide variation among hospitals.
Factors linked to death included older age, male sex, higher body mass index, coronary artery disease, active cancer, and the presence of low oxygen levels, liver dysfunction, and kidney dysfunction at the time of ICU admission.
Even after adjusting for a variety of risk factors, death rates varied widely across hospitals, from 6% to 80%. The number of pre-COVID ICU beds in the hospital was strongly linked to the death rate.
Patients admitted to hospitals with less than 50 ICU beds had a more than three-fold higher risk of death than patients admitted to hospitals with 100 or more ICU beds.
In addition, hospitals varied widely in the proportion of patients who received medications and supportive therapy for COVID-19.
During the time period studied, hydroxychloroquine, azithromycin, and anticoagulants were commonly prescribed, and interventions such as prone positioning were also being implemented.
But the proportion of patients receiving these measures varied considerably—for instance, the use of prone positioning ranged from 4% of patients at one hospital to 80 percent at another.
The team says differences in death rates across hospitals may be impacted by other confounders, such as the socioeconomic status of patients—a risk factor increasingly recognized as important in health outcomes for COVID-19 patients.
The study confirms that certain factors, such as older age and higher BMI, are associated with an increased risk of death.
It also identified several novel risk factors for death, such as treatment at a hospital with fewer ICU beds.
One author of the study is David E. Leaf, MD, MMSc, an associate physician in the Division of Renal Medicine at the Brigham.
The study is published in JAMA Internal Medicine.
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