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dc.contributor.authorDennis, J. M.
dc.contributor.authorMcGovern, A. P.
dc.contributor.authorThomas, N. J.
dc.contributor.authorWilde, H.
dc.contributor.authorVollmer, S. J.
dc.contributor.authorMateen, B. A.
dc.identifier.citationCrit Care Med. 2021 Nov 1;49(11):1895-1900. doi: 10.1097/CCM.0000000000005184.
dc.description.abstractOBJECTIVES: To determine whether the previously described trend of improving mortality in people with coronavirus disease 2019 in critical care during the first wave was maintained, plateaued, or reversed during the second wave in United Kingdom, when B117 became the dominant strain. DESIGN: National retrospective cohort study. SETTING: All English hospital trusts (i.e., groups of hospitals functioning as single operational units), reporting critical care admissions (high dependency unit and ICU) to the Coronavirus Disease 2019 Hospitalization in England Surveillance System. PATIENTS: A total of 49,862 (34,336 high dependency unit and 15,526 ICU) patients admitted between March 1, 2020, and January 31, 2021 (inclusive). INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: The primary outcome was inhospital 28-day mortality by calendar month of admission, from March 2020 to January 2021. Unadjusted mortality was estimated, and Cox proportional hazard models were used to estimate adjusted mortality, controlling for age, sex, ethnicity, major comorbidities, social deprivation, geographic location, and operational strain (using bed occupancy as a proxy). Mortality fell to trough levels in June 2020 (ICU: 22.5% [95% CI, 18.2-27.4], high dependency unit: 8.0% [95% CI, 6.4-9.6]) but then subsequently increased up to January 2021: (ICU: 30.6% [95% CI, 29.0-32.2] and high dependency unit, 16.2% [95% CI, 15.3-17.1]). Comparing patients admitted during June-September 2020 with those admitted during December 2020-January 2021, the adjusted mortality was 59% (CI range, 39-82) higher in high dependency unit and 88% (CI range, 62-118) higher in ICU for the later period. This increased mortality was seen in all subgroups including those under 65. CONCLUSIONS: There was a marked deterioration in outcomes for patients admitted to critical care at the peak of the second wave of coronavirus disease 2019 in United Kingdom (December 2020-January 2021), compared with the post-first-wave period (June 2020-September 2020). The deterioration was independent of recorded patient characteristics and occupancy levels. Further research is required to determine to what extent this deterioration reflects the impact of the B117 variant of concern.
dc.publisherWolters Kluwer
dc.rights© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
dc.subjectAge Factors
dc.subjectAged, 80 and over
dc.subjectBed Occupancy
dc.subjectCritical Care
dc.subjectHospital Mortality/*trends
dc.subjectLength of Stay
dc.subjectMiddle Aged
dc.subjectRetrospective Studies
dc.subjectUnited Kingdom/epidemiology
dc.subjectYoung Adult
dc.titleTrends in 28-Day Mortality of Critical Care Patients With Coronavirus Disease 2019 in the United Kingdom: A National Cohort Study, March 2020 to January 2021
dc.typeJournal Article
dc.identifier.journalCritical care medicine
dc.identifier.pmcidPMC8507592 received support for article research from Diabetes UK. Dr. McGovern’s institution received funding from Eli Lilly and Company, Pfizer, and AstraZeneca. Drs. Thomas and Mateen received support for article research from Wellcome Trust/Charities Open Access Fund. Dr. Thomas disclosed that he is a Wellcome funded PhD student. Dr. Vollmer received funding from IQVIA; he received support for article research from Research Councils UK. Dr. Mateen disclosed that he is an employee of Wellcome Trust and holds a Wellcome funded honorary post at University College London for the purposes of carrying out independent research; the views expressed in this article do not necessarily reflect the views of the Wellcome Trust. Dr. Dennis is supported by a Research England’s Expanding Excellence in England Independent Fellowship. Mr. Wilde is supported by the Feuer International Scholarship in Artificial Intelligence. Drs. Vollmer and Mateen are supported by The Alan Turing Institute (Engineering and Physical Science Research Council grant EP/N510129/). Dr. Vollmer is supported by the University of Warwick Impact Acceleration Account funding. Dr. Thomas is funded by a Wellcome funded GW4 Clinical Academic Training programme (GW4-CAT) PhD Fellowship (220601/Z/20/Z). Dr. Wilde has disclosed that he does not have any potential conflicts of interest.
dc.description.noteThe article is available via Open Access. Click on the 'Additional link' above to access the full-text.
dc.description.admin-notePublished version, accepted version (12 month embargo)

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© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
Except where otherwise noted, this item's license is described as © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.