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. 2021 Aug 19;11(1):127.
doi: 10.1186/s13613-021-00915-4.

Case fatality inequalities of critically ill COVID-19 patients according to patient-, hospital- and region-related factors: a French nationwide study

Antoine Guillon  1 , Emeline Laurent  2   3 , Antoine Duclos  4   5 , Lucile Godillon  2 , Pierre-François Dequin  1 , Nelly Agrinier  6 , Antoine Kimmoun  7 , Leslie Grammatico-Guillon  8   9
Affiliations

Case fatality inequalities of critically ill COVID-19 patients according to patient-, hospital- and region-related factors: a French nationwide study

Antoine Guillon et al. Ann Intensive Care. .

Abstract

Background: The COVID-19 sanitary crisis inflicted different challenges regarding the reorganization of the human and logistic resources, particularly in intensive care unit (ICU). Interdependence between regional pandemic burden and individual outcome remains unknown. The study aimed to assess the association between ICU bed occupancy and case fatality rate of critically ill COVID-19 patients.

Methods: A cross-sectional study was performed in France, using the national hospital discharge database from March to May, 2020. All patients admitted to ICU for COVID-19 were included. Case fatality was described according to: (i) patient's characteristics (age, sex, comorbid conditions, ICU interventions); (ii) hospital's characteristics (baseline ICU experience assessed by the number of ICU stays in 2019, number of ICU physicians per bed), and (iii) the regional outbreak-related profiles (workload indicator based on ICU bed occupancy). The determinants of lethal outcome were identified using a logistic regression model.

Results: 14,513 COVID-19 patients were admitted to ICU; 4256 died (29.3%), with important regional inequalities in case fatality (from 17.6 to 33.5%). Older age, multimorbidity and clinical severity were associated with higher mortality, as well as a lower baseline ICU experience of the health structure. Regions with more than 10 days with ≥ 75% of ICU occupancy by COVID-19 patients experienced an excess of mortality (up to adjusted OR = 2.2 [1.9-2.6] for region with the highest occupancy rate of ICU beds).

Conclusions: The regions with the highest burden of care in ICU were associated with up to 2.2-fold increase of death rate.

Keywords: COVID-19; Determinant of lethal outcomes; ICU.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Evolution of occupancy rate of ICU beds by COVID-19 patients, according to the French administrative region. The number of beds refers to ICU beds pre-existing before the COVID-19 crisis
Fig. 2
Fig. 2
Case fatality rate of COVID-19 patients admitted to ICU in France, March 1st to May 31st, 2020. Case fatality rate of COVID-19 patients according to: A the French administrative region, B the date of admission
See this image and copyright information in PMC

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