Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

Abstract

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID-designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO₂/FiO₂ was 121 mmHg (interquartile range (IQR), 86-171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources.

Keywords: ARDS; COVID-19; SOFA; acute hypoxemic respiratory failure; acute respiratory distress syndrome; coronavirus; coronavirus disease 2019; critical care; mortality; sequential organ failure assessment.

Figure 1

Flow diagram for study patients who were admitted to COVID-19 designated ICUs (a), and received invasive mechanical ventilation (b). Abbreviations: COVID-19 = coronavirus disease 2019, ICU = intensive care unit.

Figure 1

Flow diagram for study patients who were admitted to COVID-19 designated ICUs (a), and received invasive mechanical ventilation (b). Abbreviations: COVID-19 = coronavirus disease 2019, ICU = intensive care unit.

Figure 2

Serial SOFA scores of patients admitted to the ICU and either survived or died in ICU. Days represent ICU days. Values are medians and error bars are interquartile ranges. Numbers represent the number (n) of patients on each day. Asterisks (*) denote significant differences between those who died and those who survived on the same ICU day (p < 0.01; Mann–Whitney U test), whereas crosses (+) denote significant differences in patients who died between SOFA scores on days 10, 15 and 21 and SOFA scores on admission, day 3 or day 5 (p < 0.05; Wilcoxon matched-pair test). Abbreviations: SOFA = Sequential Organ Failure Assessment, ICU = intensive care unit.