Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis

Keywords: COVID-19, SARS-CoV-2, critical care, outcomes, mortality, risk factors

Abstract

Background: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus.

Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).

Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35–18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90–5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75–51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20–21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89–21.36).

Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation.

The full article is available at https://doi.org/10.36303/SAJAA.2020.26.3.2428

Author Biographies

E H Taylor, University of Oxford

Nuffield Department of Surgical Sciences, University of Oxford, England

R Hofmeyr, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

A Torborg, University of KwaZulu-Natal

Department of Anaesthesia, University of KwaZulu-Natal and African Perioperative Outcomes Group, South Africa

C Van Tonder, Khayelitsha District Hospital

Department of Anaesthesia, Khayelitsha District Hospital, South Africa

R Boden, University of Cape Town

University of Cape Town, South Africa

E Earle, University of the Free State

Department of Anaesthesia and Intensive Care, Universitas Academic Hospital, University of the Free State, South Africa

M Nejthardt, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

K F Kabambi, Walter Sisulu University

Department of Anaesthesia, Nelson Mandela Academic Hospital, Walter Sisulu University, South Africa

M Isaacs, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

A Usenbo, Walter Sisulu University

Department of Anaesthesia, Nelson Mandela Academic Hospital, Walter Sisulu University, South Africa

C Gerber, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

K Van der Spuy, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

B Mrara, Walter Sisulu University

Department of Anaesthesia, Nelson Mandela Academic Hospital, Walter Sisulu University, South Africa

T Ndhlovu, Walter Sisulu University

Department of Anaesthesia, Nelson Mandela Academic Hospital, Walter Sisulu University, South Africa

A Chen, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

J Swanevelder, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

J Coetzee, Stellenbosch University

Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, South Africa

B M Biccard, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

Published
2020-06-02
Section
Review Articles