Causes of Death Among Medical ICU Patients With Pneumonia Due to COVID-19 in a Safety-Net Hospital.

Autor:	Cannizzo JP; Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA., Chai AL; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA., Do CT; Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA., Wilson ML; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California. Los Angeles, CA., Liebler JM; Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA., Huerta LE; Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2023 Jul 14; Vol. 5 (7), pp. e0947. Date of Electronic Publication: 2023 Jul 14 (Print Publication: 2023).
DOI:	10.1097/CCE.0000000000000947
Abstrakt:	We sought to identify the primary causes of death of adult patients admitted to the medical ICU with symptomatic COVID-19 who ultimately suffered in-hospital mortality over the span of three major waves of COVID-19: Wild-type, alpha/epsilon, and delta. Design: Retrospective single-center cohort study from March 2020 to December 2021. Setting: One medical ICU in a 600-bed Tertiary Care Hospital in Los Angeles, CA. Patients: Adult ( n = 306) ICU patients admitted with symptomatic COVID-19 who suffered in-hospital mortality. Interventions: None. Main Results: Of the 306 patients with COVID-19 who died in the hospital, 86.3% were Hispanic/Latino. The leading cause of death was respiratory failure, occurring in 57.8% of patients. There was no significant change in the rate of pulmonary deaths across the three waves of COVID-19 in our study period. The mean time from symptom onset to admission was 6.5 days, with an average hospital length of stay of 18 days. This did not differ between pulmonary and other causes of death. Sepsis was the second most common cause of death at 23.9% with a significant decrease from the wild-type wave to the delta wave. Among patients with sepsis as the cause of death, 22% ( n = 16) were associated with fungemia. There was no significant association between steroid administration and cause of death. Lastly, the alpha/epsilon wave from December 2020 to May 2021 had the highest mortality rate when compared with wild-type or delta waves. Conclusions: We found the primary cause of death in ICU patients with COVID-19 was acute respiratory failure, without significant changes over the span of three waves of COVID-19. This finding contrasts with reported causes of death for patients with non-COVID-19 acute respiratory distress syndrome, in which respiratory failure is an uncommon cause of death. In addition, we identified a subset of patients (5%) who died primarily due to fungemia, providing an area for further investigation. Competing Interests: Supported by educational grants from the National Center for Advancing Translational Science of the U.S. National Institutes of Health, grants UL1TR001855 and UL1TR000130. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by an educational grant from the Los Angeles County Medical Center Committee for Interns and Residents. (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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