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Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU

Authors
  • Tan, Elinor1
  • Song, Jialu2
  • Deane, Adam M.1, 3
  • Plummer, Mark P.1, 3
  • 1 Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
  • 2 Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
  • 3 University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
Oct 15, 2020
Identifiers
DOI: 10.1016/j.chest.2020.10.014
PMID: 33069725
PMCID: PMC7557272
Source
PubMed Central
Keywords
License
Unknown

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented burden on the delivery of intensive care services worldwide. Research Question What is the global point estimate of deaths and risk factors for patients who are admitted to ICUs with severe COVID-19? Study Design and Methods In this systematic review and meta-analysis Medline, Embase, and the Cochrane library were searched up to August 1, 2020. Pooled prevalence of participant characteristics, clinical features, and outcome data was calculated with the use of random effects models. Subgroup analyses were based on geographic distribution, study type, quality assessment, sample size, end date, and patient disposition. Results Forty-five studies with 16,561 patients from 17 countries across four continents were included. Patients with COVID-19 who were admitted to ICUs had a mean age of 62.6 years (95% CI, 60.4-64.7). Common comorbidities included hypertension (49.5%; 95% CI, 44.9-54.0) and diabetes mellitus (26.6%; 95% CI, 22.7-30.8). More than three-quarters of cases experienced the development of ARDS (76.1%; 95% CI, 65.7-85.2). Invasive mechanical ventilation was required in 67.7% (95% CI, 59.1-75.7) of case, vasopressor support in 65.9% (95% CI, 52.4-78.4) of cases, renal replacement therapy in 16.9% (95% CI, 12.1-22.2) of cases, and extracorporeal membrane oxygenation in 6.4% (95% CI, 4.1-9.1) of cases. The duration of ICU and hospital admission was 10.8 days (95% CI, 9.3-18.4) and 19.1 days (95% CI, 16.3-21.9), respectively, with in-hospital mortality rate of 28.1% (95% CI, 23.4-33.0; I2 = 96%). No significant subgroup effect was observed. Interpretation Critically ill patients with COVID-19 who are admitted to the ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global death from severe COVID-19 is <1 in 3.

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