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. 2020 Nov;46(11):2035-2047.
doi: 10.1007/s00134-020-06267-0. Epub 2020 Oct 9.

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

Alvin Richards-Belle #  1 , Izabella Orzechowska #  1 , Doug W Gould  1 , Karen Thomas  1 , James C Doidge  1 , Paul R Mouncey  1 , Michael D Christian  2 , Manu Shankar-Hari  3 , David A Harrison  1 , Kathryn M Rowan  4 ; ICNARC COVID-19 Team
Collaborators, Affiliations

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

Alvin Richards-Belle et al. Intensive Care Med. 2020 Nov.

Erratum in

Abstract

Purpose: To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19.

Methods: Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017-2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports.

Results: 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting.

Conclusion: Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.

Keywords: COVID-19; Coronavirus; Critical care; Outcomes; Pandemic.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Critical care patients with COVID-19 compared to the UK general population for age/sex, ethnicity, level of deprivation and body mass index
Fig. 2
Fig. 2
Outcomes for critical care patients with COVID-19 by age/sex, P/F ratio categories (ventilated or not in the first 24 h), APACHE II acute physiology score and type and combinations of organ support received
Fig. 3
Fig. 3
Survival to acute hospital discharge for critical care patients with COVID-19. aPatients are included in this survival analysis at day 0 if they were admitted at least two weeks prior to data extraction and censored on subsequent days after reaching either their last known follow-up date, or at two weeks prior to data extraction (whichever was earliest)
Fig. 4
Fig. 4
Acute hospital mortality for critical care patients with COVID-19 compared with other viral pneumonias (non-COVID-19) by age/sex, P/F ratio category (ventilated or not in the first 24 h), APACHE II acute physiology score and type and combinations of organ support received
See this image and copyright information in PMC

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