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      Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Rationale: Initial reports of case fatality rates (CFRs) among adults with coronavirus disease (COVID-19) receiving invasive mechanical ventilation (IMV) are highly variable.

          Objectives: To examine the CFR of patients with COVID-19 receiving IMV.

          Methods: Two authors independently searched PubMed, Embase, medRxiv, bioRxiv, the COVID-19 living systematic review, and national registry databases. The primary outcome was the “reported CFR” for patients with confirmed COVID-19 requiring IMV. “Definitive hospital CFR” for patients with outcomes at hospital discharge was also investigated. Finally, CFR was analyzed by patient age, geographic region, and study quality on the basis of the Newcastle-Ottawa Scale.

          Measurements and Results: Sixty-nine studies were included, describing 57,420 adult patients with COVID-19 who received IMV. Overall reported CFR was estimated as 45% (95% confidence interval [CI], 39–52%). Fifty-four of 69 studies stated whether hospital outcomes were available but provided a definitive hospital outcome on only 13,120 (22.8%) of the total IMV patient population. Among studies in which age-stratified CFR was available, pooled CFR estimates ranged from 47.9% (95% CI, 46.4–49.4%) in younger patients (age ≤40 yr) to 84.4% (95% CI, 83.3–85.4%) in older patients (age >80 yr). CFR was also higher in early COVID-19 epicenters. Overall heterogeneity is high ( I 2 >90%), with nonsignificant Egger’s regression test suggesting no publication bias.

          Conclusions: Almost half of patients with COVID-19 receiving IMV died based on the reported CFR, but variable CFR reporting methods resulted in a wide range of CFRs between studies. The reported CFR was higher in older patients and in early pandemic epicenters, which may be influenced by limited ICU resources. Reporting of definitive outcomes on all patients would facilitate comparisons between studies.

          Systematic review registered with PROSPERO (CRD42020186997).

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          Measuring inconsistency in meta-analyses.

          Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)
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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

            David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2012)
            David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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              Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

              Xiaobo Yang, Yuan Yu, Jiqian Xu … (2020)
              Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Respir Crit Care Med
                Journal ID (iso-abbrev): Am J Respir Crit Care Med
                Journal ID (publisher-id): ajrccm
                Title: American Journal of Respiratory and Critical Care Medicine
                Publisher: American Thoracic Society
                ISSN (Print): 1073-449X
                ISSN (Electronic): 1535-4970
                Publication date (Print and electronic): 1 January 2021
                Publication date (Electronic): 1 January 2021
                Publication date (Print): 1 January 2021
                Publication date PMC-release: 1 January 2021
                Volume: 203
                Issue: 1
                Pages: 54-66
                Affiliations
                [ 1 ]Department of Intensive Care Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
                [ 2 ]Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
                [ 3 ]Faculty of Medicine, Nursing and Health Sciences
                [ 6 ]School of Clinical Sciences at Monash Health, and
                [ 9 ]Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
                [ 4 ]Department of Intensive Care Medicine, Calvary Hospital Canberra, Canberra, Australia
                [ 5 ]Emergency Department, Monash Health, Clayton, Victoria, Australia
                [ 7 ]Department of Intensive Care Medicine, Monash Health Casey Hospital, Casey, Victoria, Australia
                [ 8 ]Department of Intensive Care Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia
                [ 10 ]Center for Integrated Critical Care, Department of Medicine and Radiology, Melbourne Medical School, Melbourne, Victoria, Australia
                [ 11 ]Department of Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
                [ 12 ]Department of Neuroanaesthesia and Neurocritical Care, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
                [ 13 ]Cambia Palliative Care Center of Excellence and
                [ 14 ]Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; and
                [ 15 ]Department of Intensive Care Medicine, Charing Cross Hospital Imperial College National Health Service Trust, London, United Kingdom
                Author notes
                Correspondence and requests for reprints should be addressed to Zheng Jie Lim, M.B. B.S., Intensive Care Resident, Ballarat Base Hospital, 1 Drummond Street North, Ballarat, VIC 3350, Australia. E-mail: zhengjie.lim@ 123456icloud.com .
                [*]

                Co–first authors.

                Author information
                http://orcid.org/0000-0001-8864-4844
                http://orcid.org/0000-0002-8292-7357
                http://orcid.org/0000-0001-8537-2011
                http://orcid.org/0000-0003-2496-6646
                http://orcid.org/0000-0001-9529-845X
                http://orcid.org/0000-0001-8644-1728
                Article
                Publisher-manuscript ID: 202006-2405OC
                DOI: 10.1164/rccm.202006-2405OC
                PMC ID: 7781141
                PubMed ID: 33119402
                SO-VID: b29ae7bc-59b1-4e38-86de-f6ad79747944
                Copyright © Copyright © 2021 by the American Thoracic Society
                License:

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 ( http://creativecommons.org/licenses/by-nc-nd/4.0/). For commercial usage and reprints, please contact Diane Gern ( dgern@ 123456thoracic.org ).

                History
                Date received : 17 June 2020
                Date accepted : 29 October 2020
                Related
                Page count
                Figures: 3, Tables: 1, Pages: 13
                Categories
                Subject: Original Articles
                Subject: COVID-19/Critical Care

                Keywords: covid-19,sars-cov-2,case fatality rate,mortality,invasive mechanical ventilation
                Data availability:
                Keywords: covid-19, sars-cov-2, case fatality rate, mortality, invasive mechanical ventilation

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