{"doi":"10.1016/j.chstcc.2023.100005","title":"ICU Mortality Across Prepandemic and Pandemic Cohorts in a Resource-Limited Setting","abstract":"BackgroundHospital adaptation and resiliency, required during public health emergencies to optimize outcomes, are understudied especially in resource-limited settings.Research QuestionWhat are the prepandemic and pandemic critical illness outcomes in a resource-limited setting and in the context of capacity strain?Study Design and MethodsWe performed a retrospective cohort study among patients admitted to ICUs at two public hospitals in the KwaZulu-Natal Department of Health in South Africa preceding and during the COVID-19 pandemic (2017-2022). We used multivariate logistic regression to analyze the association between three patient cohorts (prepandemic non-COVID-19, pandemic non-COVID-19, and pandemic COVID-19) and ICU capacity strain and the primary outcome of ICU mortality.ResultsThree thousand two hundred twenty-one patients were admitted to the ICU during the prepandemic period and 2,539 patients were admitted to the ICU during the pandemic period (n = 375 [14.8%] with COVID-19 and n = 2,164 [85.2%] without COVID-19). The prepandemic and pandemic non-COVID-19 cohorts were similar. Compared with the non-COVID-19 cohorts, the pandemic COVID-19 cohort showed older age, higher rates of chronic cardiovascular disease and diabetes, less extrapulmonary organ dysfunction, and longer ICU length of stay. Compared with the prepandemic non-COVID-19 cohort, the pandemic non-COVID-19 cohort showed similar odds of ICU mortality (OR, 1.06; 95% CI, 0.90-1.25; P = .50) whereas the pandemic COVID-19 cohort showed significantly increased odds of ICU mortality (OR, 3.91; 95% CI, 3.03-5.05 P < .0005). ICU occupancy was not associated with ICU mortality in either the COVID-19 cohort (OR, 1.05 per 10% change in ICU occupancy; 95% CI, 0.96-1.14; P = .27) or the pooled non-COVID-19 cohort (OR, 1.01 per 10% change in ICU occupancy; 95% CI, 0.98-1.03; P = .52).InterpretationPatients admitted to the ICU before and during the pandemic without COVID-19 were broadly similar in clinical characteristics and outcomes, suggesting critical care resiliency, whereas patients admitted to the ICU with COVID-19 showed important clinical differences and significantly higher mortality. Hospital adaptation and resiliency, required during public health emergencies to optimize outcomes, are understudied especially in resource-limited settings. What are the prepandemic and pandemic critical illness outcomes in a resource-limited setting and in the context of capacity strain? We performed a retrospective cohort study among patients admitted to ICUs at two public hospitals in the KwaZulu-Natal Department of Health in South Africa preceding and during the COVID-19 pandemic (2017-2022). We used multivariate logistic regression to analyze the association between three patient cohorts (prepandemic non-COVID-19, pandemic non-COVID-19, and pandemic COVID-19) and ICU capacity strain and the primary outcome of ICU mortality. Three thousand two hundred twenty-one patients were admitted to the ICU during the prepandemic period and 2,539 patients were admitted to the ICU during the pandemic period (n = 375 [14.8%] with COVID-19 and n = 2,164 [85.2%] without COVID-19). The prepandemic and pandemic non-COVID-19 cohorts were similar. Compared with the non-COVID-19 cohorts, the pandemic COVID-19 cohort showed older age, higher rates of chronic cardiovascular disease and diabetes, less extrapulmonary organ dysfunction, and longer ICU length of stay. Compared with the prepandemic non-COVID-19 cohort, the pandemic non-COVID-19 cohort showed similar odds of ICU mortality (OR, 1.06; 95% CI, 0.90-1.25; P = .50) whereas the pandemic COVID-19 cohort showed significantly increased odds of ICU mortality (OR, 3.91; 95% CI, 3.03-5.05 P < .0005). ICU occupancy was not associated with ICU mortality in either the COVID-19 cohort (OR, 1.05 per 10% change in ICU occupancy; 95% CI, 0.96-1.14; P = .27) or the pooled non-COVID-19 cohort (OR, 1.01 per 10% change in ICU occupancy; 95% CI, 0.98-1.03; P = .5","journal":"CHEST Critical Care","year":2023,"id":357806,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9269,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1044456,"name":"Stella Savarimuthu","orcid":"0000-0003-0438-2387","position":1,"is_corresponding":false},{"id":1107973,"name":"Jonathan Invernizzi","orcid":null,"position":2,"is_corresponding":false},{"id":1107974,"name":"Robyn Hyman","orcid":null,"position":3,"is_corresponding":false},{"id":1107577,"name":"Arisha Ramkillawan","orcid":"0000-0003-1958-9065","position":4,"is_corresponding":false},{"id":1107975,"name":"Creaghan Eddey","orcid":null,"position":5,"is_corresponding":false},{"id":1107578,"name":"Robert Wise","orcid":"0000-0001-5237-5582","position":6,"is_corresponding":false},{"id":1107579,"name":"Michelle Smith","orcid":"0000-0002-6954-153X","position":7,"is_corresponding":false},{"id":534917,"name":"Nikki Allorto","orcid":"0000-0001-9339-4640","position":9,"is_corresponding":false},{"id":1107976,"name":"Leesa Bishop","orcid":null,"position":10,"is_corresponding":false},{"id":1107580,"name":"Carel Cairns","orcid":"0000-0002-6193-8292","position":11,"is_corresponding":false},{"id":1107977,"name":"Sumayyah Khan","orcid":null,"position":15,"is_corresponding":false},{"id":673976,"name":"Rachel Kohn","orcid":"0000-0002-9373-5035","position":16,"is_corresponding":false},{"id":15856,"name":"Gary E. Weissman","orcid":"0000-0001-9588-3819","position":20,"is_corresponding":false},{"id":1107978,"name":"D. Wilson","orcid":null,"position":21,"is_corresponding":false},{"id":537612,"name":"George L. Anesi","orcid":"0000-0003-4585-0714","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-19T01:13:39.186262Z","pmid":"39211576","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}