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10.1001/jamainternmed.2020.3596

http://scihub22266oqcxt.onion/10.1001/jamainternmed.2020.3596
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32667668!7364338!32667668
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suck abstract from ncbi


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pmid32667668      JAMA+Intern+Med 2020 ; 180 (11): 1436-1447
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  • Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US #MMPMID32667668
  • Gupta S; Hayek SS; Wang W; Chan L; Mathews KS; Melamed ML; Brenner SK; Leonberg-Yoo A; Schenck EJ; Radbel J; Reiser J; Bansal A; Srivastava A; Zhou Y; Sutherland A; Green A; Shehata AM; Goyal N; Vijayan A; Velez JCQ; Shaefi S; Parikh CR; Arunthamakun J; Athavale AM; Friedman AN; Short SAP; Kibbelaar ZA; Abu Omar S; Admon AJ; Donnelly JP; Gershengorn HB; Hernan MA; Semler MW; Leaf DE
  • JAMA Intern Med 2020[Nov]; 180 (11): 1436-1447 PMID32667668show ga
  • IMPORTANCE: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. OBJECTIVES: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. EXPOSURES: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. MAIN OUTCOMES AND MEASURES: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. RESULTS: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (>/=80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (>/=40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs >/=300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs >/=100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. CONCLUSIONS AND RELEVANCE: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.
  • |*Intensive Care Units[MESH]
  • |Adult[MESH]
  • |Age Factors[MESH]
  • |Aged[MESH]
  • |Aged, 80 and over[MESH]
  • |COVID-19/*mortality[MESH]
  • |Critical Illness/*mortality/therapy[MESH]
  • |Female[MESH]
  • |Hospital Mortality[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Pandemics[MESH]
  • |Risk Factors[MESH]


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