The review, led by the University of Bristol and Royal United Hospitals Bath NHS Trust and published today in Anaesthesia, a journal of the Association of Anaesthetists, also shows ICU mortality for the disease is similar across the three continents included: Europe, Asia and North America.
“It may reflect the rapid learning that has taken place on a global scale due to the prompt publication of clinical reports early in the pandemic,” wrote the authors, led by Tim Cook, an anesthesiologist and intensive care physician in Bath, England.
A total of 24 observational studies including 10,150 patients were identified from centres across Asia, Europe, and North America. In patients with completed ICU admissions with COVID-19 infection, combined ICU mortality across all the studies up to the end of May was 41.6%. This represents a fall of around a third from the 59.5% ICU mortality seen in the studies up to the end of March.
The mortality rate associated with COVID-19 may be “considerably less than 1%,” instead of the 2% reported by some groups, write Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and colleagues in an editorial published February 28 in the New England Journal of Medicine.
“It may also be that ICU admission criteria have changed over time, for example, with greater pressure on ICUs early in the pandemic surge.”
The ICU mortality did not differ significantly across continents despite some evidence of variations in admission criteria, treatments delivered and the thresholds for their application. The authors say this is consistent with research findings up until the end of May suggesting that no specific therapy reduces ICU mortality. In the last few weeks dexamethasone has been found to have significant benefit and there is hope this will improve survival further.
They conclude: “This systematic review and meta-analysis of ICU outcome in patients with COVID-19 found an in-ICU mortality rate of 41.6% across international studies. There were no significant effects of geographical location, but reported ICU mortality fell over time. Optimistically, as the pandemic progresses, we may be coping better with COVID-19.”
This is consistent with research findings up until the end of May suggesting that no specific therapy reduces ICU mortality. In the last few weeks dexamethasone has been found to have significant benefit and there is hope this will improve survival further.