Infectious Disease

23% of COVID-19 deaths in US hospitals are associated with rising case numbers

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Disclosure:
Kadri reports that he has received NIH intramural funding. Warner does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Almost one in four inpatient deaths with COVID-19 may be due to hospital stress caused by rising case numbers, according to a recent study in Annals of Internal Medicine.

“Several US hospitals experienced a sharp increase in their COVID-19 case numbers during this pandemic,” Sameer S. Kadri, MD, MS, Head of epidemiology in the Intensive Care Unit at the NIH Clinical Center, said in a video accompanying the study. “A key question remained, how much of the enormous death toll was linked to simply being admitted to swelling hospitals rather than the infection itself?”

Source: Kadri SS, et al. Anna Intern Med. 2021; doi: 10.7326 / M21-1213.

Kadri and colleagues analyzed data from 144,116 people with COVID-19 who were admitted to one of 558 U.S. hospitals from March 1, 2020 to August 31, 2020. The patients were discharged or had died by October 31, 2020. The hospitals hospital were part of the Premier Healthcare Database, which contains all payers and one-fifth of all hospital admissions in 48 states. The researchers also checked the data and the number of patients involved in COVID-19 case spikes that were occurring in the hospitals.

The researchers reported that of 144,116 inpatients, 78,144 (54.2%) were admitted to hospitals in the top decile of the increase index.

Of the total cohort, 25,344 (17.6%) died. Although raw COVID-19 mortality decreased over time across all surge index layers compared to the non-increasing COVID-19 hospital months (less than the 50th. The adjusted OR was 1.11 (95% CI, 1.01-1.23) in the 50th to 75th increase index percentile; 1.24 (95% CI, 1.12-1.38) in the 75th to 90th increase index percentile; 1.42 (95% CI, 1.27-1.6) in the 90th to 95th increase index percentile; 1.59 (95% CI, 1.41-1.8) in the 95th to 99th increase index percentile; and 2 (95 % CI, 1.69–2.38) in the 99th percentile of the increase index.

According to Kadri and colleagues, the increase index was also linked to mortality in wards, intensive care units, and intubation. The association was larger from June to August compared to March to May (slope difference = 0.1; 95% CI, 0.03-0.16), even with increasing use of corticosteroids and “more careful intubation,” the researchers wrote.

Overall, Kadri and colleagues estimated that 23.2% of deaths were possibly due to exposure to hospitals.

“A really humiliating statistic,” said Kadri in the video. “Our results have implications for triage, hospital readiness, resource allocation and public health benchmarking.”

Sarah Warner, MPH, A senior data manager at NIH said in the video that the impact of hospital congestion “may have been worse in other global regions where existing healthcare infrastructure is initially limited”.

“We hope our work will identify potential future threats from emerging worrying variants,” she said.

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