Factors associated with death in critically ill patients with coronavirus disease 2019 in the US
Open accessAbstract
Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. Conclusions and Relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.
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Male gender is a risk factor for severe COVID-19.
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- Authors
- Gupta, S., Hayek, S. S., Wang, W., Chan, L., Mathews, K. S., Melamed, M. L., Brenner, S. K., Leonberg-Yoo, A., Schenck, E. J., Radbel, J., Reiser, J., Bansal, A., Srivastava, A., Zhou, Y., Sutherland, A., Green, A., Shehata, A. M., Goyal, N., Vijayan, A., Velez, J. C. Q., Shaefi, S., Parikh, C. R., Arunthamakun, J., Athavale, A. M., Friedman, A. N., Short, S. A. P., Kibbelaar, Z. A., Abu Omar, S., Admon, A. J., Donnelly, J. P., Gershengorn, H. B., Hernán, M. A., Semler, M. W., Leaf, D. E., STOP-COVID Investigators, Walther, C. P., Anumudu, S. J., Kopecky, K. F., Milligan, G. P., McCullough, P. A., Nguyen, T.-D., Krajewski, M. L., Shankar, S., Pannu, A., Valencia, J. D., Waikar, S. S., Hart, P., Ajiboye, O., Itteera, M., Rachoin, J.-S., Schorr, C. A., Shea, L., Edmonston, D. L., Mosher, C. L., Karp, A., Cohen, Z., Allusson, V., Bambrick-Santoyo, G., Bhatti, N. U. A., Mehta, B., Williams, A., Walters, P., Go, R. C., Rose, K. M., Zhou, A. M., Kim, E. C., Lisk, R., Coca, S. G., Altman, D. R., Saha, A., Soh, H., Wen, H. H., Bose, S., Leven, E. A., Wang, J. G., Mosoyan, G., Nadkarni, G. N., Guirguis, J., Kapoor, R., Meshberger, C., Garibaldi, B. T., Corona-Villalobos, C. P., Wen, Y., Menez, S., Malik, R. F., Cervantes, C. E., Gautam, S. C., Nguyen, H. B., Ahoubim, A., Thomas, L. F., Sirganagari, D. R., Guru, P. K., Bergl, P. A., Rodriguez, J., Shah, J. A., Gupta, M. S., Kumar, P. N., Lazarous, D. G., Kassaye, S. G., Johns, T. S., Mocerino, R., Prudhvi, K., Zhu, D., Levy, R. V., Azzi, Y., Fisher, M., Yunes, M., Sedaliu, K., Golestaneh, L., Brogan, M., Raichoudhury, R., Cho, S. J., Plataki, M., Alvarez-Mulett, S. L., Gomez-Escobar, L. G., Pan, D., Lee, S., Kirshnan, J., Whalen, W., Charytan, D., Macina, A., Ross, D. W., Leidner, A. S., Martinez, C., Kruser, J. M., Wunderink, R. G., Hodakowski, A. J., Price-Haywood, E. G., Matute-Trochez, L. A., Hasty, A. E., Mohamed, M. M., Avasare, R. S., Zonies, D., Baron, R. M., Sise, M. E., Newman, E. T., Pokharel, K. K., Sharma, S., Singh, H., Correa, S., Shaukat, T., Kamal, O., Yang, H., Boateng, J. O., Lee, M., Strohbehn, I. A., Li, J., Muhsin, S. A., Mandel, E. I., Mueller, A. L., Cairl, N. S., Rowan, C., Madhai-Lovely, F., Peev, V., Byun, J. J., Vissing, A., Kapania, E. M., Post, Z., Patel, N. P., Hermes, J.-M., Patrawalla, A., Finkel, D. G., Danek, B. A., Arikapudi, S., Paer, J. M., Puri, S., Sunderram, J., Scharf, M. T., Ahmed, A., Berim, I., Hussain, S., Anand, S., Levitt, J. E., Garcia, P., Boyle, S. M., Song, R., Zhang, J., Sharshir, M. A., Rusnak, V. V., Podoll, A. S., Chonchol, M., Sharma, S., Burnham, E. L., Rashidi, A., Hejal, R., Judd, E. T., Latta, L., Tolwani, A., Albertson, T. E., Adams, J. Y., Chang, S. Y., Beutler, R. M., Schulze, C. E., Macedo, E., Rhee, H., Liu, K. D., Jotwani, V. K., Koyner, J. L., Shah, C. V., Jaikaransingh, V., Toth-Manikowski, S. M., Joo, M. J., Lash, J. P., Neyra, J. A., Chaaban, N., Iardino, A., Au, E. H., Sharma, J. H., Sosa, M. A., Taldone, S., Contreras, G., Zerda, D. D. L., Blakely, P., Berlin, H., Azam, T. U., Shadid, H., Pan, M., O'Hayer, P., Meloche, C., Feroze, R., Padalia, K. J., Bitar, A., Flythe, J. E., Tugman, M. J., Brown, B. R., Spiardi, R. C., Miano, T. A., Roche, M. S., Vasquez, C. R., Bansal, A. D., Ernecoff, N. C., Kovesdy, C. P., Molnar, M. Z., Azhar, A., Hedayati, S. S., Nadamuni, M. V., Khan, S. S., Willett, D. L., Renaghan, A. D., Bhatraju, P. K., Malik, B. A., Joy, C. M., Li, T., Goldberg, S., Kao, P. F., Schumaker, G. L., Faugno, A. J., Hsu, C. M., Tariq, A., Meyer, L., Weiner, D. E., Christov, M., Wilson, F. P., Arora, T., & Ugwuowo, U.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Michigan (US)
- Icahn School of Medicine at Mount Sinai (US)
- Albert Einstein College of Medicine (US)
- Hackensack University Medical Center (US)
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Weill Cornell Medicine (US)
- Rutgers, The State University of New Jersey (US)
- Rush University Medical Center (US)
- University of Colorado Anschutz (US)
- Northwestern University (US)
- Medical College of Wisconsin (US)
- Rutgers New Jersey Medical School (US)
- Cooper Norcross Health (US)
- Hackensack University Medical Center Mountainside (US)
- Tufts Medical Center (US)
- Washington University in St. Louis (US)
- Ochsner Health System (US)
- Beth Israel Deaconess Medical Center (US)
- Johns Hopkins University (US)
- Baylor University Medical Center (US)
- John H. Stroger, Jr. Hospital of Cook County (US)
- Indiana University Indianapolis (US)
- University of Vermont (US)
- Renal Section, Boston Medical Center, Boston, Massachusetts
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Vanderbilt University Medical Center (US)
- for the STOP-COVID Investigators
- Corresponding author
- Leaf, David E.
- ORCID
- Gupta, Shruti
- Hayek, Salim S.
- Wang, Wei
- Chan, Lili
- Mathews, Kusum S.
- Melamed, Michal L.
- Schenck, Edward J.
- Radbel, Jared
- Reiser, Jochen
- Srivastava, Anand
- Sutherland, Anne
- Green, Adam
- Goyal, Nitender
- Vijayan, Anitha
- Velez, Juan Carlos Q.
- Shaefi, Shahzad
- Parikh, Chirag R.
- Arunthamakun, Justin
- Athavale, Ambarish M.
- Friedman, Allon N.
- Short, Samuel A. P.
- Admon, Andrew J.
- Donnelly, John P.
- Gershengorn, Hayley B.
- Semler, Matthew W.
- Leaf, David E.
- Walther, Carl P
- Anumudu, Samaya J
- Milligan, Gregory P
- McCullough, Peter A
- Nguyen, Thuy-Duyen
- Valencia, Juan D
- Waikar, Sushrut S
- Ajiboye, Oyintayo
- Schorr, Christa A
- Shea, Lisa
- Edmonston, Daniel L
- Mosher, Christopher L
- Mehta, Bijal
- Williams, Aquino
- Lisk, Rebecca
- Coca, Steven G
- Altman, Deena R
- Saha, Aparna
- Wen, Huei Hsun
- Bose, Sonali
- Leven, Emily A
- Mosoyan, Gohar
- Nadkarni, Girish N
- Guirguis, John
- Kapoor, Rajat
- Garibaldi, Brian T
- Wen, Yumeng
- Menez, Steven
- Malik, Rubab F
- Cervantes, Carmen Elena
- Gautam, Samir C
- Guru, Pramod K
- Bergl, Paul A
- Kumar, Princy N
- Kassaye, Seble G
- Johns, Tanya S
- Prudhvi, Kalyan
- Zhu, Denzel
- Levy, Rebecca V
- Azzi, Yorg
- Fisher, Molly
- Golestaneh, Ladan
- Brogan, Maureen
- Cho, Soo Jung
- Plataki, Maria
- Alvarez-Mulett, Sergio L
- Pan, Di
- Lee, Stefi
- Whalen, William
- Charytan, David
- Ross, Daniel W
- Leidner, Alexander S
- Kruser, Jacqueline M
- Wunderink, Richard G
- Hodakowski, Alexander J
- Mohamed, Muner MB
- Avasare, Rupali S
- Zonies, David
- Baron, Rebecca M
- Sise, Meghan E
- Newman, Erik T
- Sharma, Shreyak
- Singh, Harkarandeep
- Correa, Simon
- Lee, Meghan
- Strohbehn, Ian A
- Li, Jiahua
- Muhsin, Saif A
- Mandel, Ernest I
- Mueller, Ariel L
- Peev, Vasil
- Byun, John J
- Vissing, Andrew
- Kapania, Esha M
- Patrawalla, Amee
- Danek, Barbara A
- Arikapudi, Sowminya
- Sunderram, Jag
- Scharf, Matthew T
- Ahmed, Ayesha
- Berim, Ilya
- Anand, Shuchi
- Levitt, Joseph E
- Boyle, Suzanne M
- Song, Rui
- Zhang, Jingjing
- Chonchol, Michel
- Sharma, Sunita
- Burnham, Ellen L
- Rashidi, Arash
- Latta, Laura
- Tolwani, Ashita
- Albertson, Timothy E
- Adams, Jason Y
- Chang, Steven Y
- Macedo, Etienne
- Rhee, Harin
- Liu, Kathleen D
- Jotwani, Vasantha K
- Koyner, Jay L
- Shah, Chintan V
- Jaikaransingh, Vishal
- Lash, James P
- Neyra, Javier A
- Iardino, Alfredo
- Sosa, Marie Anne
- Taldone, Sabrina
- Blakely, Pennelope
- Berlin, Hanna
- Azam, Tariq U
- Shadid, Husam
- Pan, Michael
- Meloche, Chelsea
- Bitar, Abbas
- Flythe, Jennifer E
- Brown, Brent R
- Spiardi, Ryan C
- Miano, Todd A
- Bansal, Amar D
- Ernecoff, Natalie C
- Kovesdy, Csaba P
- Molnar, Miklos Z
- Azhar, Ambreen
- Hedayati, Susan S
- Nadamuni, Mridula V
- Khan, Sadaf S
- Willett, Duwayne L
- Renaghan, Amanda D
- Bhatraju, Pavan K
- Joy, Christina Mariyam
- Li, Tingting
- Goldberg, Seth
- Kao, Patricia F
- Faugno, Anthony J
- Hsu, Caroline M
- Tariq, Asma
- Meyer, Leah
- Weiner, Daniel E
- Wilson, Francis P
- Arora, Tanima
- Ugwuowo, Ugochukwu
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-11-01
- Volume
- 180
- Issue
- 11
- Pages
- 1436
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC7364338
- OpenAlex
- W3042021285
- Cited by
- 957
- References
- 25
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 91 · 2023: 117 · 2022: 208 · 2021: 389 · 2020: 108
- FWCI
- 26.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- Vanderbilt University
- University of Miami
- Massachusetts Institute of Technology
- Tufts Medical Center
- Northwestern University
- Washington University in St. Louis
- Baylor University
- Johns Hopkins University
- Harvard T.H. Chan School of Public Health
- Vanderbilt University Medical Center
- Ochsner Health
- Hackensack Meridian Health
- University of Queensland
- National Institutes of Health (UL1TR002389, UL1TR001863)
- Feinberg School of Medicine
- Medical School, University of Michigan
- Leonard M. Miller School of Medicine
- School of Medicine, Indiana University
- Baylor University Medical Center
- Anschutz Medical Campus, University of Colorado
- Larner College of Medicine, University of Vermont
- National Institute on Aging (R03AG060179)
- National Heart, Lung, and Blood Institute (R01HL153384, L30 HL149016, F32HL149337, K23HL130648)
- National Institute of General Medical Sciences (K08GM134220)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK120811, K23DK116967, K23DK124644, L60 DK126281)
- National Institute of Environmental Health Sciences (P30ES005022)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- COVID-19 pandemic, critically ill patients, in-hospital mortality, mortality risk factors, interhospital variation, intensive care unit outcomes, comorbidities, organ dysfunction, sex differences, body mass index, coronary artery disease, ICU bed capacity, hospital characteristics, treatment variation, mortality prediction model, 28-day mortality, 90-day mortality
- MeSH terms
- COVID-19, Adult, Age Factors, Aged, Aged, 80 and over, Female, Humans, Intensive Care Units, Male, Middle Aged, Risk Factors, United States, Critical Illness, Hospital Mortality, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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