Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Massimiliano Greco, Thomas De Corte, Ari Ercole, Massimo Antonelli, Elie Azoulay, Giuseppe Citerio, Andy Conway Morris, Gennaro De Pascale, Frantisek Duska, Paul Elbers, Sharon Einav, Lui Forni, Laura Galarza, Armand R.J. Girbes, Giacomo Grasselli, Vitaly Gusarov, Alasdair Jubb, Jozef Kesecioglu, Andrea Lavinio, Maria Cruz Martin DelgadoJohannes Mellinghoff, Sheila Nainan Myatra, Marlies Ostermann, Mariangela Pellegrini, Pedro Póvoa, Stefan J. Schaller, Jean Louis Teboul, Adrian Wong, Jan De Waele, Maurizio Cecconi, Marco Bezzi, Alicia Gira, Philipp Eller, Tarikul Hamid, Injamam Ull Haque, Wim De Buyser, Antonella Cudia, Daniel De Backer, Pierre Foulon, Vincent Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean Baptiste Mesland, Patrick Biston, Michael Piagnerelli, Lionel Haentjens, Nicolas De Schryver

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Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Original languageEnglish
Pages (from-to)690-705
Number of pages16
JournalIntensive Care Medicine
Issue number6
Publication statusPublished - Jun 2022


  • COVID-19
  • Critical care
  • Pneumonia
  • SARS-CoV-2
  • Surge capacity


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