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. 2021 Sep 1;49(9):1439-1450.
doi: 10.1097/CCM.0000000000004972.

Surge and Mortality in ICUs in New York City's Public Healthcare System

Alexander T Toth  1 , Kathleen S Tatem  2 , Nicole Hosseinipour  2 , Taylor Wong  1 , Remle Newton-Dame  2 , Gabriel M Cohen  3 , Annie George  4 , Thomas Sessa  5 , Radu Postelnicu  1 , Amit Uppal  1 , Nichola J Davis  2 , Vikramjit Mukherjee  1
Affiliations

Surge and Mortality in ICUs in New York City's Public Healthcare System

Alexander T Toth et al. Crit Care Med. .

Abstract

Objectives: To evaluate the impact of ICU surge on mortality and to explore clinical and sociodemographic predictors of mortality.

Design: Retrospective cohort analysis.

Setting: NYC Health + Hospitals ICUs.

Patients: Adult ICU patients with coronavirus disease 2019 admitted between March 24, and May 12, 2020.

Interventions: None.

Measurements and main results: Hospitals reported surge levels daily. Uni- and multivariable analyses were conducted to assess factors impacting in-hospital mortality. Mortality in Hispanic patients was higher for high/very high surge compared with low/medium surge (69.6% vs 56.4%; p = 0.0011). Patients 65 years old and older had similar mortality across surge levels. Mortality decreased from high/very high surge to low/medium surge in, patients 18-44 years old and 45-64 (18-44 yr: 46.4% vs 27.3%; p = 0.0017 and 45-64 yr: 64.9% vs 53.2%; p = 0.002), and for medium, high, and very high poverty neighborhoods (medium: 69.5% vs 60.7%; p = 0.019 and high: 71.2% vs 59.7%; p = 0.0078 and very high: 66.6% vs 50.7%; p = 0.0003). In the multivariable model high surge (high/very high vs low/medium odds ratio, 1.4; 95% CI, 1.2-1.8), race/ethnicity (Black vs White odds ratio, 1.5; 95% CI, 1.1-2.0 and Asian vs White odds ratio 1.5; 95% CI, 1.0-2.3; other vs White odds ratio 1.5, 95% CI, 1.0-2.3), age (45-64 vs 18-44 odds ratio, 2.0; 95% CI, 1.6-2.5 and 65-74 vs 18-44 odds ratio, 5.1; 95% CI, 3.3-8.0 and 75+ vs 18-44 odds ratio, 6.8; 95% CI, 4.7-10.1), payer type (uninsured vs commercial/other odds ratio, 1.7; 95% CI, 1.2-2.3; medicaid vs commercial/other odds ratio, 1.3; 95% CI, 1.1-1.5), neighborhood poverty (medium vs low odds ratio 1.6, 95% CI, 1.0-2.4 and high vs low odds ratio, 1.8; 95% CI, 1.3-2.5), comorbidities (diabetes odds ratio, 1.6; 95% CI, 1.2-2.0 and asthma odds ratio, 1.4; 95% CI, 1.1-1.8 and heart disease odds ratio, 2.5; 95% CI, 2.0-3.3), and interventions (mechanical ventilation odds ratio, 8.8; 95% CI, 6.1-12.9 and dialysis odds ratio, 3.0; 95% CI, 1.9-4.7) were significant predictors for mortality.

Conclusions: Patients admitted to ICUs with higher surge scores were at greater risk of death. Impact of surge levels on mortality varied across sociodemographic groups.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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