Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study

• Main Authors: McLarty, Joshua, Litton, Edward, Beane, Abigail, Aryal, Diptesh, Bailey, Michael, Bendel, Stepani, Burghi, Gaston, Christensen, Steffen, Christiansen, Christian Fynbo, Dongelmans, Dave A, Fernandez, Ariel L, Ghose, Aniruddha, Hall, Ros, Haniffa, Rashan, Hashmi, Madiha, Hashimoto, Satoru, Ichihara, Nao, Tirupakuzhi Vijayaraghavan, Bharath Kumar, Lone, Nazir I, Arias López, Maria del Pilar, Mat Nor, Mohd Basri, Okamoto, Hiroshi, Priyadarshani, Dilanthi, Reinikainen, Matti, Soares, Marcio, Pilcher, David, Salluh, Jorge
• Format: Article
• Language: English; English; English; English
• Published: BMJ Publishing Group Ltd. 2023
• Subjects: RC731 Specialties of Internal Medicine-Diseases of The Respiratory System; RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
• Online Access: http://irep.iium.edu.my/106465/1/thorax-2022-219592.full.pdf; http://irep.iium.edu.my/106465/7/106465_Non-COVID-19%20intensive%20care%20admissions%20during%20the%20pandemic_SCOPUS-In%20Press.pdf; http://irep.iium.edu.my/106465/13/106465_Non-COVID-19%20intensive%20care%20admissions%20during%20the%20pandemic_Scopus.pdf; http://irep.iium.edu.my/106465/14/106465_Non-COVID-19%20intensive%20care%20admissions%20during%20the%20pandemic_Published.pdf; http://irep.iium.edu.my/106465/; https://thorax.bmj.com/content/thoraxjnl/early/2023/05/24/thorax-2022-219592.full.pdf

Background: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, There is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. Methods: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. Findings: Among 1 642 632 non-COVID-19 admissions, There was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. Interpretation: Increased ICU mortality occurred among non-COVID- 19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.