Prevalence, characteristics and longer-term outcomes of patients with persistent critical illness due to COVID-19 in Scotland: a national cohort study

Blayney, M. C. et al. (2022) Prevalence, characteristics and longer-term outcomes of patients with persistent critical illness due to COVID-19 in Scotland: a national cohort study. British Journal of Anaesthesia, 128(6), pp. 980-989. (doi: 10.1016/j.bja.2022.03.017) (PMID:35465954) (PMCID:PMC8942655)

Abstract

Background: Patients with coronavirus disease (COVID-19) can require critical care for prolonged periods. Patients with Persistent Critical Illness can have complex recovery trajectories but this has not been researched for patients with COVID-19. We examined the prevalence, risk factors and long-term outcomes of critically ill COVID-19 patients with persistent critical illness. Methods: A national cohort study of all adults admitted to Scottish critical care units with COVID-19 from 01/03/20 to 04/09/21. Persistent critical illness was defined as a critical care length of stay (LOS) of ≥10 days. Outcomes included one-year mortality and hospital readmission following critical care discharge. Fine and Gray competing risk analysis was used to identify factors associated with Persistent Critical Illness with death as a competing risk. Results: 2236 patients with COVID-19 were admitted to critical care. 1045 patients were identified as developing Persistent Critical Illness, comprising 46.7% of the cohort but using 80.6% of bed-days. Persistent Critical Illness patients used more organ support, had longer post-critical care LOS and longer total hospital LOS. Persistent critical illness was not significantly associated with long-term mortality or hospital readmission. Risk factors associated with increased hazard of Persistent Critical Illness include age, illness severity, organ support on admission and fewer comorbidities. Conclusion: Almost half of all critical care patients with COVID-19 develop persistent critical illness, with high resource use in critical care and beyond. However, persistent critical illness was not associated with a significantly worse long-term outcomes compared to patients who were critically ill for shorter periods.

• Item Type: Articles
• Keywords: COVID-19, intensive care, long-term ventilation, mortality, readmission.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McPeake, Dr Jo and Puxty, Dr Kathryn
• Authors: Blayney, M. C., Stewart, N. I., Kaye, C. T., Puxty, K., Chan Seem, R., Donaldson, L., Haddow, C., Hall, R., Martin, C., Paton, M., Lone, N. I., and McPeake, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: British Journal of Anaesthesia
• Publisher: Elsevier
• ISSN: 0007-0912
• ISSN (Online): 1471-6771
• Published Online: 24 March 2022
• Copyright Holders: Copyright © 2022 British Journal of Anaesthesia
• First Published: First published in British Journal of Anaesthesia 128(6): 980-989
• Publisher Policy: Reproduced in accordance with the publisher copyright policy

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
307748		Improving health and social care integration delivery in the acute care environment	Joanne McPeake	University of Cambridge (HEI-CAMB)	RG88620	HW - MRC/CSO Social and Public Health Sciences Unit