Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study
Joshua McLarty 1 2, Edward Litton 3 4, Abigail Beane 5 6, Diptesh Aryal 7, Michael Bailey 2, Stepani Bendel 8 9, Gaston Burghi 10, Steffen Christensen 11, Christian Fynbo Christiansen 12, Dave A Dongelmans 13 14, Ariel L Fernandez 15, Aniruddha Ghose 16, Ros Hall 17, Rashan Haniffa 5 6, Madiha Hashmi 18, Satoru Hashimoto 19 20, Nao Ichihara 21, Bharath Kumar Tirupakuzhi Vijayaraghavan 22 23, Nazir I Lone 24, Maria Del Pilar Arias López 25 26, Mohamed Basri Mat Nor 27, Hiroshi Okamoto 28, Dilanthi Priyadarshani 29, Matti Reinikainen 8 9, Marcio Soares 30, David Pilcher 31 2, Jorge Salluh 30 32; Linking of Global Intensive Care (LOGIC) Collaboration
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.
Keywords: COVID-19; Clinical Epidemiology; Critical Care.
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict Of Interest Statement
Competing interests: DP and Dr EL are members of the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation management committee. AB is funded by Wellcome. JS and MS are cofounders and shareholders of Epimed Solutions, a healthcare cloud-based analytics company. They are also supported in part by individual research grants from CNPq and FAPERJ. SB is the current chair, and MR is the past chair of the Finnish Intensive Care Consortium (both unpaid). DAD is unpaid chair of NICE foundation. NI’s primary affiliation is the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by National Clinical Database, Johnson & Johnson K.K., and Nipro corporation. BKTV is the National Coordinator for the Indian Registry of IntenSive care (IRIS) and is supported for 0.5 FTE by funding from the Wellcome Trust, UK. The remaining authors have no conflicts of interest to declare.