Characteristics and Outcomes of 4,942 Critically Ill Adult Patients with COVID-19 in Brazil

Background: The spread of COVID-19 increased the stress of health systems globally, obligating adjustments to improve the management of severe cases. What are the impacts of preparedness measures on the outcomes of the COVID-19 critically ill patients? Our study aimed to analyze the clinical characteristics, resource use, and risk factors associated with 30-day in-hospital mortality of critically ill adult patients with COVID-19 requiring ICU admission in a network of Brazilian hospitals.Methods: A multicenter cohort of COVID-19-confirmed patients requiring ICU admission at 42 Brazilian hospitals between February 27th and June 27th, 2020. The primary outcome was 30-day in-hospital mortality. We evaluated the association of clinical characteristics, ICU resource use, and risk factors using a random-effects multivariable cox regression model, in which the hospital was the random intercept. Secondary outcomes were the length-of-stay, ICU, and in-hospital mortality, and the use of mechanical ventilation during hospitalization.Findings: From 4,942 patients, 713 (14·4%) died 30 days after the ICU admission. The median age was 56 (IQR: [43,72]) years, 38% of patients were over 60 years-old, and 41% were women. Being older than 70 years (70-79, Hazard Ratio [95%CI]: 1·95[1·3-2·93]; ≥ 80, 3·96[2·66-5·89]), frail (MFI≥3, 1·65 [1·26-2·15]) and requiring, early or late, invasive Mechanical Ventilation (48h, 3·26 [2·46-4·32]) were independently associated with 30-day mortality. In 1,400 ventilated patients, 30-day mortality was 44·4% (622/1,400), the median duration of mechanical ventilation was ten days (IQR [6,16]), and ICU length of stay was 17 days (IQR [10,26]). Those who died within 30 days were more often older than 80 years (≥80: 37% vs. 14%) and previously frail (35% vs. 19%) compared to the survivors.Interpretation: In this large cohort, critically ill COVID-19 patients showed reasonable survival rates, including those requiring mechanical ventilation. Factors associated with worse outcome were age, frailty, and early need for invasive ventilation. Adequate preparedness, early hospitalization, and no shortage of critical care resources were probably key to achieve such results.Funding: The National Council for Scientific and Technological Development (CNPq); the Coordination for the Improvement of Higher Education Personnel (CAPES); the Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ); the Pontifical Catholic University of Rio de Janeiro and the D’Or Institute for Research and Education.Declaration of Interests: Dr. Soares and Dr. Salluh are founders and equity shareholders of Epimed Solutions®, which commercializes the Epimed Monitor System®, a cloud-based software for ICU management and benchmarking. The other authors declare that they have no conflict of interest.Ethics Approval Statement: Local Ethics Committee and the Brazilian National Ethics Committee (CAAE: 17079119.7.0000.5249) approved the study without the need for informed consent.