Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

PLoS One. 2023 Nov 2;18(11):e0293883. doi: 10.1371/journal.pone.0293883. eCollection 2023.

Abstract

Background: To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy.

Methods: In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients.

Results: We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality.

Conclusion: Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • Critical Illness
  • Humans
  • Hypertension*
  • Intensive Care Units
  • Patient Discharge
  • Prospective Studies
  • Retrospective Studies

Grants and funding

This study was funded by a research grant (PD/BD/150529/2019) from the Portuguese foundation FCT (Fundação para a Ciência e a Tecnologia). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.