Hospital and Temporal Variations in Limitations of Care Among Hospitalized Patients with COVID-19: A VIRUS Registry Retrospective Cohort Study.
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Mesfin Nathan, Kumar Jain Nitesh, Khedr Anwar, Mushtaq Hisham, Jama Abbas B, Attallah Noura, Hassan Esraa, Langworthy Benjamin, Ingraham Nicholas, Garces Juan Pablo Domecq, Koritala Thoyaja, Armaignac Donna Lee, Perkins Nicholas Eugene, Belden Katherine, Kumar Vishakha, Boman Karen, Sanghavi Devang K, Bansal Vikas, Kashyap Rahul, Cartin-Ceba Rodrigo, Nou Abigail La, Walkey Allan J, Dudley R Adams, Khan Syed Anjum, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): Covid-19 Registry Investigator Group
Аннотация
METHODS: We included all adults admitted to a hospital in the United States with COVID-19 from January 2020 to December 2021 using the VIRUS registry. Our outcome was any life-support limitation on admission (DNR, DNI, or both) using regression modeling. Main exposures were hospital and period of hospitalization (early vs. late pandemic). Covariates included age, sex, race/ethnicity, comorbidities, and hospitalization diagnoses.
RESULTS: There were 42,383 patients from 75 hospitals in the US. The median age was 63 (interquartile range: 50-75), 46.5% were female, and 37.5% were non-Hispanic White. The life-support limitation rate was 7.9%, and the palliative care consultation rate was 2.3%. The odds of life-support limitation were 1.86 (95% CI: 1.6-2.1) depending on the hospital, but the period of hospitalization was not associated with odds of life-support limitation. Older age was associated with the greatest increased odds (4.1 per standard deviation ∼ 17.9 years, 95% CI: 3.9-4.4), followed by comorbidities including paralysis (2.4, 95% CI: 1.8-3.0) and dementia (2.3, 95% CI: 2.0-2.6).
CONCLUSIONS: After adjusting for patient-level factors, we report significant inter-hospital but no temporal variation in life-support limitation upon admission with COVID-19. Future studies should investigate specific practices that led to health care resilience to temporal practice variations in life-support limitation during the pandemic.