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. 2023 Jul 14;5(7):e0947.
doi: 10.1097/CCE.0000000000000947. eCollection 2023 Jul.

Causes of Death Among Medical ICU Patients With Pneumonia Due to COVID-19 in a Safety-Net Hospital

Joseph P Cannizzo  1 , Audrey L Chai  2 , Christopher T Do  3 , Melissa L Wilson  4 , Janice M Liebler  3 , Luis E Huerta  3
Affiliations

Causes of Death Among Medical ICU Patients With Pneumonia Due to COVID-19 in a Safety-Net Hospital

Joseph P Cannizzo et al. Crit Care Explor. .

Abstract

We sought to identify the primary causes of death of adult patients admitted to the medical ICU with symptomatic COVID-19 who ultimately suffered in-hospital mortality over the span of three major waves of COVID-19: Wild-type, alpha/epsilon, and delta.

Design: Retrospective single-center cohort study from March 2020 to December 2021.

Setting: One medical ICU in a 600-bed Tertiary Care Hospital in Los Angeles, CA.

Patients: Adult (n = 306) ICU patients admitted with symptomatic COVID-19 who suffered in-hospital mortality.

Interventions: None.

Main results: Of the 306 patients with COVID-19 who died in the hospital, 86.3% were Hispanic/Latino. The leading cause of death was respiratory failure, occurring in 57.8% of patients. There was no significant change in the rate of pulmonary deaths across the three waves of COVID-19 in our study period. The mean time from symptom onset to admission was 6.5 days, with an average hospital length of stay of 18 days. This did not differ between pulmonary and other causes of death. Sepsis was the second most common cause of death at 23.9% with a significant decrease from the wild-type wave to the delta wave. Among patients with sepsis as the cause of death, 22% (n = 16) were associated with fungemia. There was no significant association between steroid administration and cause of death. Lastly, the alpha/epsilon wave from December 2020 to May 2021 had the highest mortality rate when compared with wild-type or delta waves.

Conclusions: We found the primary cause of death in ICU patients with COVID-19 was acute respiratory failure, without significant changes over the span of three waves of COVID-19. This finding contrasts with reported causes of death for patients with non-COVID-19 acute respiratory distress syndrome, in which respiratory failure is an uncommon cause of death. In addition, we identified a subset of patients (5%) who died primarily due to fungemia, providing an area for further investigation.

Keywords: COVID-19; death; fungemia; respiratory distress syndrome; respiratory failure.

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Conflict of interest statement

Supported by educational grants from the National Center for Advancing Translational Science of the U.S. National Institutes of Health, grants UL1TR001855 and UL1TR000130. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by an educational grant from the Los Angeles County Medical Center Committee for Interns and Residents.

Figures

Figure 1.
Figure 1.
Causes of death among patients with COVID-19 admitted to the MICU from March 2020 to December 2021. MICU = medical ICU, UTI = Urinary tract infection identified by positive urine culture.
Figure 2.
Figure 2.
Total ICU deaths due to COVID-19 per month in a single safety-net hospital.
Figure 3.
Figure 3.
Causes of death among COVID-19 patients by wave of COVID-19. The pulmonary causes are subdivided from top to bottom as: hypoxic, hypercapneic, and both. There were no purely hypercapneic cases during the delta wave. Sepsis was subdivided from the top down as: other/unknown, urinary tract infection, pneumonia, fungemia, and bacteremia. There were no urinary tract infections during the wild wave. The delta wave sepsis was caused by only “other/unknown” and bacteremia.
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References

    1. World Health Organization: WHO coronavirus (COVID-19) dashboard | WHO coronavirus (COVID-19) dashboard with vaccination data, 2022. Available at: https://covid19.who.int/. Accessed December 5, 2022
    1. Barouch DH: COVID-19 vaccines—immunity, variants, boosters. N Engl J Med 2022; 387:1011–1020 - PMC - PubMed
    1. Kim L, Garg S, O’Halloran A, et al. : Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) [Internet]. Clin Infect Dis 2021; 72:e206–e214 - PMC - PubMed
    1. Wiersinga WJ, Rhodes A, Cheng AC, et al. : Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA 2020; 324:782–793 - PubMed
    1. Variants - Coronavirus COVID-19 response. Calif Dep Public Heal Genomic Surveill Data 2022. Available at: https://covid19.ca.gov/variants/. Accessed November 22, 2022