Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study

McLarty J 1 , Litton E 2 , Beane A 3 , Aryal D 4 , Bailey M 5 , Bendel S 6 Show all authors , Burghi G 7 , Christensen S 8 , Christiansen CF 9 , Dongelmans DA 10 , Fernandez AL 11 , Ghose A 12 , Hall R 13 , Haniffa R 3 , Hashmi M 14 , Hashimoto S 15 , Ichihara N 16 , Kumar Tirupakuzhi Vijayaraghavan B 17 , Lone NI 18 , Arias López MDP 19 , Mat Nor MB 20 , Okamoto H 21 , Priyadarshani D 22 , Reinikainen M 6 , Soares M 23 , Pilcher D 24 , Salluh J 23 , Linking of Global Intensive Care (LOGIC) Collaboration

Affiliations 

  • 1 Alfred Hospital, Melbourne, Victoria, Australia j.mclarty@alfred.org.au
  • 2 St John of God Hospital Subiaco, Perth, Western Australia, Australia
  • 3 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
  • 4 Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
  • 5 Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
  • 6 Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
  • 7 Hospital Maciel, Montevideo, Uruguay
  • 8 Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
  • 9 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
  • 10 Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  • 11 SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
  • 12 Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
  • 13 Public Health Scotland, Edinburgh, UK
  • 14 Ziauddin University, Karachi, Pakistan
  • 15 Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • 16 The University of Tokyo, Bunkyo-ku, Japan
  • 17 The George Institute for Global Health India, New Delhi, Delhi, India
  • 18 Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  • 19 Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
  • 20 Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
  • 21 St Luke's International Hospital, Tokyo, Japan
  • 22 NICS-MORU, Colombo, Sri Lanka
  • 23 D'Or Institute for Research and Education, Rio de Janeiro, Brazil
  • 24 Alfred Hospital, Melbourne, Victoria, Australia
Thorax, 2024 Jan 18;79(2):120-127.
PMID: 37225417 DOI: 10.1136/thorax-2022-219592

Abstract

BACKGROUND: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment.

METHODS: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry.

FINDINGS: Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes.

INTERPRETATION: Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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