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In the current Omicron surge, severity of COVID-19 is relatively low, fewer patients require hospitalization, and effective medications have been developed. But how do patients fare who, despite these advances (as well as rising herd immunity and reduced pathogenicity of the variants), progress to respiratory failure requiring intubation? Investigators queried a federally funded database involving almost 63,000 adults admitted with a new COVID-19 diagnosis between February 2020 and January 2022 to 21 U.S. hospitals.
In multivariate analysis, intubation was strongly associated with in-hospital mortality (odds ratio [OR], 31.3). Among other parameters associated with mortality (e.g., race, sex, body-mass index, comorbidity index), age had the strongest effect (relative to age 20–29, OR ranged from 1.6 [age 30–39] to 30.8 (age >90]). For those requiring ventilation, mortality was higher during the Delta surge (adjusted OR, 1.31) compared with Alpha and Omicron, with the highest absolute mortality (>50%) among those aged 70–79 during all three surges. Full vaccination was protective regarding overall mortality (OR, 0.66) but had no significant effect on mortality among those requiring ventilation during all surges.
Nolan MB et al. Mortality by age group and intubation status in adult hospitalized patients from 21 U.S. hospital systems during three surges of the COVID-19 pandemic. Chest 2023 Jan 30; [e-pub]. (https://doi.org/10.1016/j.chest.2023.01.029)
Comment
Even during the Omicron era with its perceived low severity of disease, mortality is alarmingly high among those with COVID-19 necessitating ventilator support. Although greater mortality during the Delta surge may be related to viral factors, it also reflects increased use of noninvasive ventilation, thereby selecting sicker patients for invasive ventilation. The data suggest that preventing progression to critical illness is essential to lowering mortality in people with COVID-19.