Comorbid burden at ICU admission in COVID‐19 compared to sepsis and acute respiratory distress syndrome

Author:

Ahlström Björn12ORCID,Frithiof Robert1,Larsson Ing‐Marie1,Strandberg Gunnar1,Lipcsey Miklos13,Hultström Michael14ORCID

Affiliation:

1. Anesthesiology and Intensive Care, Department of Surgical Sciences Uppsala University Uppsala Sweden

2. Centre for Clinical Research Dalarna Healthcare Region Dalarna Falun Sweden

3. Hedenstierna laboratory, Department of Surgical Sciences Uppsala University Uppsala Sweden

4. Integrative Physiology, Department of Medical Cell Biology Uppsala University Uppsala Sweden

Abstract

AbstractBackgroundComorbidities are similarly associated with short‐term mortality for COVID‐19, acute respiratory distress syndrome (ARDS) and sepsis in intensive care unit (ICU) patients, but their adjusted frequencies at admission are unknown. Thus, we aimed to evaluate the adjusted distribution, reported as odds ratios, of known risk factors (i.e., age, sex and comorbidities) for ICU admission between COVID‐19, sepsis and ARDS patients in this nationwide registry‐based study.MethodsIn this cohort study, we included adult patients admitted to Swedish ICUs with COVID‐19 (n = 7382) during the pandemic and compared them to patients admitted to ICU with sepsis (n = 22,354) or ARDS (n = 2776) during a pre‐COVID‐19 period. The main outcomes were the adjusted odds for comorbidities, sex, and age in multivariable logistic regression on diagnostic categories in patients admitted to ICU, COVID‐19 or sepsis and COVID‐19 or ARDS.ResultsWe found that most comorbidities, as well as age, had a stronger association with sepsis admission than COVID‐19 admission with the exception of male sex, type 2 diabetes mellitus, and asthma that were more strongly associated with COVID‐19 admission, while no difference was seen for chronic renal failure and obesity. For COVID‐19 and ARDS admission most risk factors were more strongly associated with ARDS admission except for male sex, type 2 diabetes mellitus, chronic renal failure, and obesity which were more strongly associated with COVID‐19 admission, whereas hypertension, chronic obstructive pulmonary disease and asthma were not different.ConclusionsPatients admitted to ICU with sepsis or ARDS carry a heavier burden of comorbidity and high age than patients admitted with COVID‐19. This is likely caused by a combination of: (1) respiratory failure in COVID‐19 being less dependent on comorbidities than in other forms of ARDS, and the cause of critical illness in other infections causing sepsis and (2) COVID‐19 patients being deferred admission in situations where patients with the other syndromes were admitted.

Publisher

Wiley

Reference42 articles.

1. Coronavirus resource center: Johns Hopkins University of Medicine;2022https://coronavirus.jhu.edu/.

2. The Epidemiology of Acute Respiratory Distress Syndrome Before and After Coronavirus Disease 2019

3. Global report on the epidemiology and burden of sepsis.2021.

4. Acute respiratory distress syndrome: the Berlin definition;Force ADT;JAMA,2012

5. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

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