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Infectious diseases Respiratory disease Anaesthetics Health services administration
Volume 221 - Issue 4

Outcomes for people admitted to Australian and New Zealand intensive care units with primary, exacerbating, or incidental SARS‐CoV‐2 infections, 2022–23: a retrospective analysis of ANZICS data

Authors:  Alastair Brown, Andrew Udy, Martyn Kirk, Sonya Bennett, Shaila Chavan, Sue Huckson and David Pilcher

Med J Aust 2024 || doi: 10.5694/mja2.52390
Published online: 5 August 2024

SARS-CoV-2 infections are still associated with poorer clinical outcomes for people admitted to ICUs 

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Abstract

Objectives: To compare in‐hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022–23 with coronavirus disease 2019 (COVID‐19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections, or without SAR‐CoV‐2 infections.

Study design: Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data.

Setting, participants: Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 – 30 June 2023.

Major outcome measures: The primary outcome was in‐hospital mortality, the secondary outcome ICU length of stay, each by SARS‐CoV‐2 infection attribution classification: primary COVID‐19; exacerbating SARS‐CoV‐2 infection (SARS‐CoV‐2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS‐CoV‐2 infections (SARS‐CoV‐2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS‐CoV‐2 infection.

Results: A total of 207684 adults were admitted to 195 Australian and New Zealand ICUs during 2022–23; 2674 people (1.3%) had incidental SARS‐CoV‐2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID‐19. Unadjusted in‐hospital mortality for people with incidental SARS‐CoV‐2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID‐19 (830 deaths, 22.9%), but higher than for patients without SARS‐CoV‐2 infections (15486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS‐CoV‐2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10–1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22–1.48), or primary COVID‐19 (aOR, 2.54; 95% CI, 2.30–2.81) than for patients without SARS‐CoV‐2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4–4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2–1.5 hours) than for those without SARS‐CoV‐2 infections.

Conclusion: Risk‐adjusted in‐hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS‐CoV‐2 infections than for people who do not.

Authors

  • Alastair Brown1,2
  • Andrew Udy1,3
  • Martyn Kirk4
  • Sonya Bennett4
  • Shaila Chavan5
  • Sue Huckson1,5
  • David Pilcher2,5
  • 1. Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
  • 2. St Vincent's Hospital, Melbourne, VIC
  • 3. The Alfred, Melbourne, VIC
  • 4. Australian Department of Health and Aged Care, Canberra, ACT
  • 5. Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC

Correspondence: alastair.brown@monash.edu


Open access:

Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

 

Data sharing

Requests for access to ANZICS CORE data can be made to anzics.core@anzics.org.

Competing interests

No relevant disclosures.

Acknowledgements

Alastair Brown is supported by a Research Training Program scholarship provided by the Australian government. Martyn Kirk is supported by a National Health and Medical Research Council fellowship (GNT1145997).

We acknowledge the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) for providing the data we analysed. The authors and the management committee of ANZICS CORE thank the clinicians, data collectors, and researchers at the contributing sites (listed in the Supporting Information).

References

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