Predisposing factors for admission to intensive care units of patients with COVID-19 infection-Results of the German nationwide inpatient sample

Karsten Keller; Ioannis T Farmakis; Luca Valerio; Sebastian Koelmel; Johannes Wild; Stefano Barco; Frank P Schmidt; Christine Espinola-Klein; Stavros Konstantinides; Thomas Münzel; Ingo Sagoschen; Lukas Hobohm

doi:10.3389/fpubh.2023.1113793

Predisposing factors for admission to intensive care units of patients with COVID-19 infection-Results of the German nationwide inpatient sample

Front Public Health. 2023 Feb 15:11:1113793. doi: 10.3389/fpubh.2023.1113793. eCollection 2023.

Authors

Karsten Keller^{1

2

3}, Ioannis T Farmakis², Luca Valerio^{1

2}, Sebastian Koelmel⁴, Johannes Wild¹, Stefano Barco^{2

5}, Frank P Schmidt⁶, Christine Espinola-Klein^{1

2}, Stavros Konstantinides^{2

7}, Thomas Münzel^{1

8}, Ingo Sagoschen¹, Lukas Hobohm^{1

2}

Affiliations

¹ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
³ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
⁴ Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland.
⁵ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁶ Department of Cardiology, Mutterhaus Trier, Trier, Germany.
⁷ Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
⁸ German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.

Abstract

Background: Intensive care units (ICU) capacities are one of the most critical determinants in health-care management of the COVID-19 pandemic. Therefore, we aimed to analyze the ICU-admission and case-fatality rate as well as characteristics and outcomes of patient admitted to ICU in order to identify predictors and associated conditions for worsening and case-fatality in this critical ill patient-group.

Methods: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January and December 2020. All hospitalized patients with confirmed COVID-19 infection during the year 2020 were included in the present study and were stratified according ICU-admission.

Results: Overall, 176,137 hospitalizations of patients with COVID-19-infection (52.3% males; 53.6% aged ≥70 years) were reported in Germany during 2020. Among them, 27,053 (15.4%) were treated in ICU. COVID-19-patients treated on ICU were younger [70.0 (interquartile range (IQR) 59.0-79.0) vs. 72.0 (IQR 55.0-82.0) years, P < 0.001], more often males (66.3 vs. 48.8%, P < 0.001), had more frequently cardiovascular diseases (CVD) and cardiovascular risk-factors with increased in-hospital case-fatality (38.4 vs. 14.2%, P < 0.001). ICU-admission was independently associated with in-hospital death [OR 5.49 (95% CI 5.30-5.68), P < 0.001]. Male sex [OR 1.96 (95% CI 1.90-2.01), P < 0.001], obesity [OR 2.20 (95% CI 2.10-2.31), P < 0.001], diabetes mellitus [OR 1.48 (95% CI 1.44-1.53), P < 0.001], atrial fibrillation/flutter [OR 1.57 (95% CI 1.51-1.62), P < 0.001], and heart failure [OR 1.72 (95% CI 1.66-1.78), P < 0.001] were independently associated with ICU-admission.

Conclusion: During 2020, 15.4% of the hospitalized COVID-19-patients were treated on ICUs with high case-fatality. Male sex, CVD and cardiovascular risk-factors were independent risk-factors for ICU admission.

Keywords: COVID-19; SARS-CoV-2; case-fatality; healthcare resources; intensive care unit (ICU); mortality.

MeSH terms

COVID-19 Testing
COVID-19*
Cardiovascular Diseases*
Female
Hospital Mortality
Hospitalization
Humans
Inpatients
Intensive Care Units
Male
Pandemics
Risk Factors