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Source / Disclosures
Disclosures: Kadri claims to have received intramural funds from NIH. Warner does not report any relevant financial disclosure. Please see the study for relevant financial information from all other authors.
Nearly one in four deaths among hospitalized patients with COVID-19 can be attributed to hospital strains caused by the increase in the number of cases, according to a recent study conducted in Annals of Internal Medicine.
“Several American hospitals have experienced a significant increase in their COVID-19 workload during this pandemic”, Sameer S. Kadri, MD, MS, NIH clinical center chief of epidemiology, critical care medicine department, said in a video accompanying the study. “A key question remained, how much of the massive death toll was associated with just being admitted to burgeoning hospitals, rather than with the infection itself?
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Kadri and his colleagues analyzed data on 144,116 people with COVID-19 who were admitted to one of 558 US hospitals from March 1, 2020 to August 31, 2020. Patients were discharged or died as of October 31. 2020. Hospitals were part of the Premier Healthcare database, which contains all payers and one-fifth of all hospitalizations in 48 states. Researchers also looked at the dates and number of patients involved in the outbreaks of COVID-19 cases that have occurred in hospitals.
The researchers reported that out of 144,116 inpatients, 78,144 (54.2%) were admitted to hospitals in the top decile of the surge index.
Of the entire cohort, 25,344 (17.6%) died. Although crude COVID-19 mortality has declined over time in all relapse index strata, compared to months of COVID-19 hospitalization without relapse (less than the 50th percentile of relapse index) , the researchers observed a correlation between mortality and increased relapse index. The adjusted OR was 1.11 (95% CI, 1.01-1.23) in the 50th to 75th percentile of the surge index; 1.24 (95% CI, 1.12 to 1.38) in the 75th to 90th percentile of the surge index; 1.42 (95% CI, 1.27-1.6) in the 90th to 95th percentile of the surge index; 1.59 (95% CI, 1.41-1.8) in the 95th to 99th percentile of the surge index; and 2 (95% CI, 1.69-2.38) in the percentile above the 99th percentile of the surge index.
The surge index was also linked to mortality in wards, intensive care units and intubation, according to Kadri and colleagues. The association was greater from June to August compared to March to May (difference in slope = 0.1; 95% CI, 0.03-0.16), even with increasing corticosteroid use and increased use of corticosteroids. “Smarter intubation,” the researchers wrote.
Overall, Kadri and colleagues estimated that 23.2% of deaths may have been attributable to hospital strains.
“A truly humbling statistic,” Kadri said in the video. “Our results have implications for triage, hospital readiness, resource allocation, and public health benchmarking.”
Sarah Warner, MPH, a senior data officer at NIH said in the video that the impact of hospital influxes “may have been even worse in other parts of the world, where existing health infrastructure is initially limited.”
“We hope that our work will shed light on potential future threats posed by emerging variants of concern,” she said.
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