Intensive Care and Organ Support Related Mortality in Patients with COVID-19: A Systematic Review and Meta-Analysis

Abhimanyu Chandel*, Sahar Leazer, Karl C. Alcover, Josiah Farley, Joshua Berk, Christopher Jayne, Ryan McNutt, Meredith Olsen, Rhonda Allard, Jiahong Yang, Caitlyn Johnson, Ananya Tripathi, Maria Rechtin, Mathew Leon, Mathias Williams, Phorum Sheth, Kyle Messer, Kevin K. Chung, Jacob Collen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

OBJECTIVES: To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES: A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION: Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION: Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS: One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS: We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.

Original languageEnglish
Pages (from-to)E0876
JournalCritical Care Explorations
Volume5
Issue number3
DOIs
StatePublished - 3 Mar 2023
Externally publishedYes

Keywords

  • COVID-19
  • mechanical ventilation
  • pneumonia
  • respiratory distress syndrome
  • respiratory insufficiency
  • viral

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