Cited by 114COVID-19 Clinical Research StudiesSepsis Diagnosis and TreatmentRespiratory Support and Mechanisms

Prognostic Factors for 30-Day Mortality in Critically Ill Patients With Coronavirus Disease 2019: An Observational Cohort Study

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Ferrando-Vivas, Paloma, Doidge, James, Thomas, Karen, Gould, Doug W., Mouncey, Paul, Shankar-Hari, Manu, Young, J. Duncan, Rowan, Kathryn M. +1 more·2021·Critical Care Medicine

Abstract

OBJECTIVES: To identify characteristics that predict 30-day mortality among patients critically ill with coronavirus disease 2019 in England, Wales, and Northern Ireland. DESIGN: Observational cohort study. SETTING: A total of 258 adult critical care units. PATIENTS: A total of 10,362 patients with confirmed coronavirus disease 2019 with a start of critical care between March 1, 2020, and June 22, 2020, of whom 9,990 were eligible (excluding patients with a duration of critical care less than 24 hr or missing core variables). MEASUREMENTS AND MAIN RESULTS: The main outcome measure was time to death within 30 days of the start of critical care. Of 9,990 eligible patients (median age 60 yr, 70% male), 3,933 died within 30 days of the start of critical care. As of July 22, 2020, 189 patients were still receiving critical care and a further 446 were still in acute hospital. Data were missing for between 0.1% and 7.2% of patients across prognostic factors. We imputed missing data ten-fold, using fully conditional specification and continuous variables were modeled using restricted cubic splines. Associations between the candidate prognostic factors and time to death within 30 days of the start of critical care were determined after adjustment for multiple variables with Cox proportional hazards modeling. Significant associations were identified for age, ethnicity, deprivation, body mass index, prior dependency, immunocompromise, lowest systolic blood pressure, highest heart rate, highest respiratory rate, Pa o 2/F io 2 ratio (and interaction with mechanical ventilation), highest blood lactate concentration, highest serum urea, and lowest platelet count over the first 24 hours of critical care. Nonsignificant associations were found for sex, sedation, highest temperature, and lowest hemoglobin concentration. CONCLUSIONS: We identified patient characteristics that predict an increased likelihood of death within 30 days of the start of critical care for patients with coronavirus disease 2019. These findings may support development of a prediction model for benchmarking critical care providers.

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Crossref · 10.1097/ccm.0000000000004740

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  • 30-day mortality is primarily determined by acute factors such as initial hemodynamic instability and multi-organ failure.

    “This is likely because 30-day mortality is primarily determined by acute factors such as initial hemodynamic instability and multi-organ failure [29], whereas 90-day mortality is influenced by cumulative effects of EFI over time, particularly through its impact on nutritional status.”

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Authors
Ferrando-Vivas, P., Doidge, J., Thomas, K., Gould, D. W., Mouncey, P., Shankar-Hari, M., Young, J. D., Rowan, K. M., & Harrison, D. A.
Affiliations
  • Intensive Care National Audit & Research Centre (GB)
  • Intensive Care, Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom.
  • Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
  • Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom.
Venue
Critical Care Medicine
Published
2020-10-28
Volume
49
Issue
1
Pages
102-111
ISSN
0090-3493 (ISSN-L)
OpenAlex
W3097123511
Cited by
113
References
34
Citations by year
2026: 3 · 2025: 3 · 2024: 43 · 2023: 15 · 2022: 26 · 2021: 21 · 2020: 2
FWCI
2.10
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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, 30-day mortality, prognostic factors, critically ill patients, intensive care, mortality prediction model, body mass index, immunocompromised patients, lactate, PaO2/FiO2 ratio, mechanical ventilation, blood pressure, platelet count, socioeconomic deprivation, ethnicity
MeSH terms
COVID-19, Adult, England, Female, Humans, Male, Middle Aged, Northern Ireland, Prognosis, Respiration, Artificial, Severity of Illness Index, Wales, Cohort Studies, Critical Illness, Hospital Mortality

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