Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19
Authors: Keene Adam B. , Admon Andrew J. , Brenner Samantha K. , Gupta Shruti , Lazarous Deepa , Leaf David E. , Gershengorn Hayley B. , Walther Carl P. , Anumudu Samaya J. , Arunthamakun Justin , Kopecky Kathleen F. , Milligan Gregory P. , McCullough Peter A. , Nguyen Thuy-Duyen , Shaefi Shahzad , O’Gara Brian P. , Krajewski Megan L. , Baskin Sean M. , Shankar Sidharth , Valencia Juan D. , Pannu Ameeka , Hayes Margaret M. , Grandin E. Wilson , Waikar Sushrut S. , Kibbelaar Zoe A. , Athavale Ambarish M. , Hart Peter , Upadhyay Shristi , Vohra Ishaan , Oyintayo Ajiboye , Green Adam , Rachoin Jean-Sebastien , Schorr Christa A. , Shea Lisa , Edmonston Daniel L. , Mosher Christopher L. , Shehata Alexandre M. , Cohen Zaza , Allusson Valerie , Bambrick-Santoyo Gabriela , ul aain Bhatti Noor , Mehta Bijal , Williams Aquino , Brenner Samantha K. , Walters Patricia , Go Ronaldo C. , Rose Keith M. , Hernán; Miguel A. , Lisk Rebecca , Chan Lili , Mathews Kusum S. , Coca Steven G. , Altman Deena R. , Saha Aparna , Soh Howard , Wen Huei Hsun , Bose Sonali , Leven Emily A. , Wang Jing G. , Mosoyan Gohar , Nadkarni Girish N. , Pattharanitima Pattharawin , Gallagher Emily J. , Friedman Allon N. , Guirguis John , Kapoor Rajat , Meshberger Christopher , Kelly Katherine J. , Parikh Chirag R. , Garibaldi Brian T. , Corona-Villalobos Celia P. , Wen Yumeng , Menez Steven , Malik Rubab F. , Elena Cervantes Carmen , Gautam Samir C. , Mallappallil Mary C. , Ouyang Jie , John Sabu , Yap Ernie , Melaku Yohannes , Mohamed Ibrahim , Bajracharya Siddhartha , Puri Isha , Thaxton Mariah , Bhattacharya Jyotsna , Wagner John , Boudourakis Leon , Nguyen H. Bryant , Ahoubim Afshin , Thomas Leslie F. , Sirganagari Dheeraj Reddy , Guru Pramod K. , Kashani Kianoush , Tehranian Shahrzad , Zhou Yan , Bergl Paul A. , Rodriguez Jesus , Shah Jatan A. , Gupta Mrigank S. , Kumar Princy N. , Lazarous Deepa G. , Kassaye Seble G. , Melamed Michal L. , Johns Tanya S. , Mocerino Ryan , Prudhvi Kalyan , Zhu Denzel , Levy Rebecca V. , Azzi Yorg , Fisher Molly , Yunes Milagros , Sedaliu Kaltrina , Golestaneh Ladan , Brogan Maureen , Kumar Neelja , Chang Michael , Thakkar Jyotsana , Raichoudhury Ritesh , Athreya Akshay , Farag Mohamed , Schenck Edward J. , Jung Cho Soo , Plataki Maria , Alvarez-Mulett Sergio L. , Gomez-Escobar Luis G. , Pan Di , Lee Stefi , Krishnan Jamuna , Whalen William , Charytan David , Macina Ashley , Chaudhry Sobaata , Wu Benjamin , Modersitzki Frank , Srivastava Anand , Leidner Alexander S. , Martinez Carlos , Kruser Jacqueline M. , Wunderink Richard G. , Hodakowski Alexander J. , Velez Juan Carlos Q. , Price-Haywood Eboni G. , Matute-Trochez Luis A. , Hasty Anna E. , Mohamed Muner MB. , Avasare Rupali S. , Zonies David , Leaf David E. , Gupta Shruti , Sise Meghan E. , Newman Erik T. , Abu Omar Samah , Pokharel Kapil K. , Sharma Shreyak , Singh Harkarandeep , Correa Simon , Shaukat Tanveer , Kamal Omer , Wang Wei , Yang Heather , Boateng Jeffery O. , Lee Meghan , Strohbehn Ian A. , Li Jiahua , Mueller Ariel L. , Redfern Roberta E. , Cairl Nicholas S. , Naimy Gabriel , Abu-Saif Abeer , Hall Danyell , Bickley Laura , Rowan Chris , Madhani-Lovely Farah , Peev Vasil , Reiser Jochen , Byun John J. , Vissing Andrew , Kapania Esha M. , Post Zoe , Patel Nilam P. , Hermes Joy-Marie , Sutherland Anne K. , Patrawalla Amee , Finkel Diana G. , Danek Barbara A. , Arikapudi Sowminya , Paer Jeffrey M. , Cangialosi Peter , Liotta Mark , Radbel Jared , Puri Sonika , Sunderram Jag , Scharf Matthew T. , Ahmed Ayesha , Berim Ilya , Vatson Jayanth S. , Anand Shuchi , Levitt Joseph E. , Garcia Pablo , Boyle Suzanne M. , Song Rui , Arif Ali , Zhang Jingjing , Woo Sang Hoon , Deng Xiaoying , Katz-Greenberg Goni , Senter Katharine , Sharshir Moh’d A. , Rusnak Vadym V. , Imran Ali Muhammad , Peters Terri , Hughes Kathy , Bansal Anip , Podoll Amber S. , Chonchol Michel , Sharma Sunita , Burnham Ellen L. , Rashidi Arash , Hejal Rana , Judd Eric , Latta Laura , Tolwani Ashita , Albertson Timothy E. , Adams Jason Y. , Chang Steven Y. , Beutler Rebecca M. , Schulze Carl E. , Macedo Etienne , Rhee Harin , Liu Kathleen D. , Jotwani Vasantha K. , Koyner Jay L. , Kunczt Alissa , Shah Chintan V. , Jaikaransingh Vishal , Toth-Manikowski Stephanie M. , Joo Min J. , Lash James P. , Neyra Javier A. , Chaaban Nourhan , Elias Madona , Ahmad Yahya , Dy Rajany , Iardino Alfredo , Au Elizabeth H. , Sharma Jill H. , Anne Sosa Marie , Taldone Sabrina , Contreras Gabriel , De La Zerda David , Fornoni Alessia , Gershengorn Hayley B. , Hayek Salim S. , Blakely Pennelope , Berlin Hanna , Azam Tariq U. , Shadid Husam , Pan Michael , O” Hayer Patrick , Meloche Chelsea , Feroze Rafey , Padalia Kishan J. , Bitar Abbas , Leya Jeff , Donnelly John P. , Admon Andrew J. , Flythe Jennifer E. , Tugman Matthew J. , Chang Emily H. , Brown Brent R. , Leonberg-Yoo Amanda K. , Spiardi Ryan C. , Miano Todd A. , Roche Meaghan S. , Vasquez Charles R. , Bansal Amar D. , Ernecoff Natalie C. , Kapoor Sanjana , Verma Siddharth , Chen Huiwen , Kovesdy Csaba P. , Molnar Miklos Z. , Azhar Ambreen , Susan Hedayati S. , Nadamuni Mridula V. , Shastri Shani , Willett Duwayne L. , Short Samuel A.P. , Renaghan Amanda D. , Enfield Kyle B. , Bhatraju Pavan K. , Bilal Malik A. , Semler Matthew W. , Vijayan Anitha , Mariyam Joy Christina , Li Tingting , Goldberg Seth , Kao Patricia F. , Schumaker Greg L. , Goyal Nitender , Faugno Anthony J. , Schumaker Greg L. , Hsu Caroline M. , Tariq Asma , Meyer Leah , Kshirsagar Ravi K. , Jose Aju , Weiner Daniel E. , Christov Marta , Chugh Savneek , Griffiths Jennifer , Gupta Sanjeev , Kapoor Aromma , Chugh Savneek , Wilson Perry , Arora Tanima , Ugwuowo Ugochukwu 
Published: December 2021

Objective

To determine whether surge conditions were associated with increased mortality.

Design

Multicenter cohort study.

Setting

U.S. ICUs participating in STOP-COVID.

Patients

Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020.

Interventions

None

Measurements and Main Results

The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals). Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001).

Conclusions

Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.