Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025
In-hospital mortality in patients admitted to Australian intensive care units with COVID-19 between 2020 and 2024.
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Donnan Matthew T, Zhao Peinan, Cheng Allen C, Ibrahim Aaliya, Palermo Annamaria, Reddi Benjamin, Reynolds Claire, French Craig, Litton Edward, Rotherham Hannah, Begum Husna, Cooper Jamie, Dumbrell Jodi, Campbell Lewis, Plummer Mark, Ramanan Mahesh, Alliegro Patricia, McAllister Richard E, Erickson Simon, Priyadarshini Shweta, Ng Sze, Broadley Tessa, Trapani Tony, Papanikolaou Vicki, Cheung Winston, Udy Andrew A, Burrell Aidan
Аннотация
OBJECTIVE: To describe and compare the demographics, management, and outcomes for patients with COVID-19 admitted to intensive care units (ICUs) in Australia across the various waves of the COVID pandemic.
DESIGN SETTING AND PARTICIPANTS: People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.
MAIN OUTCOME MEASURES: Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.
RESULTS: From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The Wild Type wave included 518 (5.1%) patients, the Delta wave 2467 (24.3%) patients, and the Omicron wave 7186 (70.7%) patients. The median (IQR) age was 61 (49-70) years, 54 (41-66) years, and 65 (45-75) years, respectively (P < 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the Omicron subvariant waves (range 60.0%-71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P < 0.001). Use of extracorporeal membrane oxygenation was highest during the Delta wave (3.6%, 83 patients, median duration 18 days [IQR 9.8-35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the Delta (adjusted HR 1.80, 95% CI: 1.38-2.35, p < 0.001) and Omicron (adjusted HR 1.88, 95% CI: 1.46-2.42, p < 0.001) waves when compared to the Wild Type wave.
CONCLUSION: COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the Omicron wave demonstrated the highest in-hospital mortality.
DESIGN SETTING AND PARTICIPANTS: People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.
MAIN OUTCOME MEASURES: Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.
RESULTS: From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The Wild Type wave included 518 (5.1%) patients, the Delta wave 2467 (24.3%) patients, and the Omicron wave 7186 (70.7%) patients. The median (IQR) age was 61 (49-70) years, 54 (41-66) years, and 65 (45-75) years, respectively (P < 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the Omicron subvariant waves (range 60.0%-71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P < 0.001). Use of extracorporeal membrane oxygenation was highest during the Delta wave (3.6%, 83 patients, median duration 18 days [IQR 9.8-35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the Delta (adjusted HR 1.80, 95% CI: 1.38-2.35, p < 0.001) and Omicron (adjusted HR 1.88, 95% CI: 1.46-2.42, p < 0.001) waves when compared to the Wild Type wave.
CONCLUSION: COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the Omicron wave demonstrated the highest in-hospital mortality.