A paper co-authored by Zhaozhi Qian, Ahmed Alaa, and Mihaela van der Schaar has been accepted for publication in Intensive Care Medicine (editor-in-chief: Giuseppe Citerio, M. D.). Dr. Ari Ercole from the University of Cambridge’s Division of Anaesthesia collaborated on the paper.
Using hospitalization data from England, the paper explores a variety of risk predictors associated with ICU outcome for COVID-19 patients. The key outcome of this research, however, is the striking and concerning degree of between-centre variation in outcome, the cause of which is unknown. Hazard ratio variation between sites is found to be comparable in magnitude to the strongest predictor (age), meaning that a patient’s place of treatment may potentially have as significant an impact on survival as any other single factor.
The authors note that these findings motivate urgent comparative effectiveness research to characterise between-centre differences to inform surge best-practice in both in England and elsewhere.
The high numbers of COVID-19 patients developing severe respiratory failure has placed exceptional demands on ICU capacity around the world. Understanding the determinants of ICU mortality is important for surge planning and shared decision making. We used early data from the COVID-19 Hospitalisation in England Surveillance System (from the start of data collection 8th February -22nd May 2020) to look for factors associated with ICU outcome in the hope that information from such timely analysis may be actionable before the outbreak peak. Immunosuppressive disease, chronic cardiorespiratory/renal disease and age were key determinants of ICU mortality in a proportional hazards mixed effects model. However variation in site-stratified random effects were comparable in magnitude suggesting substantial between-centre variability in mortality. Notwithstanding possible ascertainment and lead-time effects, these early results motivate comparative effectiveness research to understand the origin of such differences and optimise surge ICU provision.
For a full list of the van der Schaar Lab’s publications, click here.
To find out more about the van der Schaar Lab’s work related to the COVID-19 pandemic, visit our dedicated page here.