Due to the large number of patients with severe COVID-19, many were treated outside of the traditional walls of the ICU, and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside of the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the ISARIC WHO COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or non-invasive mechanical ventilation, high-flow nasal cannula, inotropes, and vasopressors. A logistic Generalised Additive Model was used to compare clinical outcomes among patients admitted and not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median [IQR], 67 years [55, 78]), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 days (5–19) and was longer in patients admitted to an ICU than in those that were cared for outside of ICU (12 [6–23] versus 8 [4–15] days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% [5797/18831] versus 39.0% [7532/19295], p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR:0.70, 95%CI: 0.65-0.75, p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside of an ICU.


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Reyes, L., Murthy, S., Garcia-Gallo, E., Irvine, M., Merson, L., Martin-Loeches, I., Rello, J., Taccone, F., Fowler, R., Docherty, A., Kartsonaki, C., Aragao, I., Barrett, P., Beane, A., Burrell, A., Cheng, M., Christian, M., Cidade, J., Citarella, B., Donnelly, C., Fernandes, S., French, C., Haniffa, R., Harrison, E., Ho, A., Joseph, M., Khan, I., Kho, M., Kildal, A., Kutsogiannis, D., Lamontagne, F., Lee, T., Bassi, G., Lopez Revilla, J., Marquis, C., Millar, J., Neto, R., Nichol, A., Parke, R., Pereira, R., Poli, S., Povoa, P., Ramanathan, K., Rewa, O., Riera, J., Shrapnel, S., Joao Silva, M., Udy, A., Uyeki, T., Webb, S., Wils, E., Rojek, A. & Olliaro, P. 2022, 'Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the ISARIC WHO Clinical Characterisation Protocol: A prospective, multinational, multicentre, observational study', ERJ Open Research, 8(1), article no: 00552-2021. http://dx.doi.org/10.1183/23120541.00552-2021

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Last updated: 29 August 2023
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