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. 2023 Feb 15:11:1113793.
doi: 10.3389/fpubh.2023.1113793. eCollection 2023.

Predisposing factors for admission to intensive care units of patients with COVID-19 infection-Results of the German nationwide inpatient sample

Karsten Keller  1   2   3 , Ioannis T Farmakis  2 , Luca Valerio  1   2 , Sebastian Koelmel  4 , Johannes Wild  1 , Stefano Barco  2   5 , Frank P Schmidt  6 , Christine Espinola-Klein  1   2 , Stavros Konstantinides  2   7 , Thomas Münzel  1   8 , Ingo Sagoschen  1 , Lukas Hobohm  1   2
Affiliations

Predisposing factors for admission to intensive care units of patients with COVID-19 infection-Results of the German nationwide inpatient sample

Karsten Keller et al. Front Public Health. .

Abstract

Background: Intensive care units (ICU) capacities are one of the most critical determinants in health-care management of the COVID-19 pandemic. Therefore, we aimed to analyze the ICU-admission and case-fatality rate as well as characteristics and outcomes of patient admitted to ICU in order to identify predictors and associated conditions for worsening and case-fatality in this critical ill patient-group.

Methods: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January and December 2020. All hospitalized patients with confirmed COVID-19 infection during the year 2020 were included in the present study and were stratified according ICU-admission.

Results: Overall, 176,137 hospitalizations of patients with COVID-19-infection (52.3% males; 53.6% aged ≥70 years) were reported in Germany during 2020. Among them, 27,053 (15.4%) were treated in ICU. COVID-19-patients treated on ICU were younger [70.0 (interquartile range (IQR) 59.0-79.0) vs. 72.0 (IQR 55.0-82.0) years, P < 0.001], more often males (66.3 vs. 48.8%, P < 0.001), had more frequently cardiovascular diseases (CVD) and cardiovascular risk-factors with increased in-hospital case-fatality (38.4 vs. 14.2%, P < 0.001). ICU-admission was independently associated with in-hospital death [OR 5.49 (95% CI 5.30-5.68), P < 0.001]. Male sex [OR 1.96 (95% CI 1.90-2.01), P < 0.001], obesity [OR 2.20 (95% CI 2.10-2.31), P < 0.001], diabetes mellitus [OR 1.48 (95% CI 1.44-1.53), P < 0.001], atrial fibrillation/flutter [OR 1.57 (95% CI 1.51-1.62), P < 0.001], and heart failure [OR 1.72 (95% CI 1.66-1.78), P < 0.001] were independently associated with ICU-admission.

Conclusion: During 2020, 15.4% of the hospitalized COVID-19-patients were treated on ICUs with high case-fatality. Male sex, CVD and cardiovascular risk-factors were independent risk-factors for ICU admission.

Keywords: COVID-19; SARS-CoV-2; case-fatality; healthcare resources; intensive care unit (ICU); mortality.

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Conflict of interest statement

SB received lecture/consultant fees from Bayer HealthCare, Concept Medical, BTG Pharmaceuticals, INARI, Boston Scientific, and LeoPharma; institutional grants from Boston Scientific, Bentley, Bayer HealthCare, INARI, Medtronic, Concept Medical, Bard, and Sanofi; and economical support for travel/congress costs from Daiichi Sankyo, BTG Pharmaceuticals, and Bayer HealthCare, outside the submitted work. CE-K reports having from Amarin Germany, Amgen GmbH, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, MSD Sharp & Dohme, Novartis Pharma, Pfizer Pharma GmbH, and Sanofi-Aventis GmbH. SKon reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; institutional grants from Inari Medical; and personal lecture/advisory fees from MSD and Bristol Myers Squibb/Pfizer. TM is PI of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. LH received lecture/consultant fees from MSD and Actelion, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow-chart. COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Figure 2
Figure 2
Temporal trends regarding total numbers of patients with COVID-19-infection admitted to ICU. (A) Temporal trends regarding total numbers of hospitalized patients with COVID-19-infection admitted to ICU (absolute numbers: blue bars; relative numbers: blue line) stratified for months. (B) Temporal trends regarding total numbers of hospitalized patients with COVID-19-infection admitted to ICU (absolute numbers: blue bars; relative numbers: blue line) stratified for age decades. COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Figure 3
Figure 3
Temporal trends regarding total numbers of patients with COVID-19-infection admitted to ICU, in-hospital case-fatality, MACCE, and VTE rate. (A) Temporal trends regarding total numbers of patients with COVID-19-infection admitted to ICU (absolute numbers: blue bars) and rates of case-fatality, MACCE, and VTE stratified for months (lines). (B) Temporal trends regarding proportion of ARDS and pneumonia in patients with COVID-19-infection admitted to ICU stratified for months. (C) Temporal trends regarding total numbers of patients with COVID-19-infection admitted to ICU (absolute numbers: blue bars) and rates of case-fatality, MACCE, and VTE stratified for age decades (lines). (D) Temporal trends regarding proportion of ARDS and pneumonia in patients with COVID-19-infection admitted to ICU stratified for age decades. COVID-19, coronavirus disease 2019; ICU, intensive care unit; VTE, venous thromboembolism; MACCE, major adverse cardiovascular and cerebrovascular events; ARDS, acute respiratory distress syndrome.
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