Table 2.
Epidemiology and outcomes of COBSI before and during SARS-CoV-2 periods by SARS-CoV-2 testing status
| July 2019-February 2020 | March 2020–September 4, 2021 | ||||
|---|---|---|---|---|---|
| Pre-pandemic period | Pandemic period | ||||
| Characteristics | SARS-CoV-2 + | SARS-CoV-2 − | SARS-CoV-2 not tested | Total | |
| 20,113 | 1638 | 27,476 | 10,590 | 39,704 | |
| Unadjusted BSI rate per 1000 admissions | 11.240 | 9.613c | 15.818c | 6.864c | 11.508a |
| Mean age ± SD, (IQR; median) | 65.1 ± 16.7 (55–78; 67) | 66.2 ± 16.2 (56–79; 68)a | 65.2 ± 16.3 (55–77; 67) | 64.6 ± 16.6 (55–77; 67)a | 65.2 ± 16.4 (55–77; 67) |
| Males, n (%) | 10,467 (52.0) | 843 (51.5) | 14,751 (53.7)b | 5560 (52.5) | 21,154 (53.3%)a |
| Prior 30-day admission, (%) | 13.2% (2655) | 16.7% (274)c | 14.4% (3945)c | 14.9% (1581)c | 14.6% (5800)c |
| Prior 90-day admission (%) | 22.7% (4572) | 27.2% (445)c | 26.9% (7393)c | 27.3% (2889)c | 27.0% (10,727)c |
| ≥1 Underlying conditionsd (%) | 86.3% (17,356) | 94.6% (1550)c | 90.7% (24,932)c | 83.9% (8889)c | 89.1% (35,371)c |
| LOS (days): avg ± SD (IQR; median) | 9.1 ± 8.3 (4–11; 7) | 12.2 ± 11.8 (5–15; 9)c | 9.2 ± 8.6 (4–11; 7) | 8.3 ± 7.8 (4–10; 6)c | 9.6 ± 8.6 (4–11; 7) |
| % Ventilatede (%) | 4.7% (954) | 10.7% (175)c | 5.4% (1490)c | 4.0% (424)a | 5.3% (2089)b |
| ICU admission (%) | 32.8% (6591) | 36.6% (600)b | 29.6% (8138)c | 26.5% (2838)c | 29.2% (11,576)c |
|
Overall LOS (days): avg ± SD (IQR; median) |
12.1 ± 10.6 (6–15; 9) | 15.5 ± 14.9 (6–20; 12)c | 12.5 ± 11.7 (6–15, 9) | 11.3 ± 10.7 (5–14; 8)c | 12.3 ± 11.7 (5–15; 9) |
|
ICU LOS (days): avg ± SD (IQR; median) |
4.7 ± 5.3 (2–6; 3) | 6.5 ± 7.4 (2–8; 4)c | 5.0 ± 6.8 (2–6; 3)a | 4.6 ± 5.5 (1–6; 3)c | 5 ± 6.6 (2–6; 3)b |
| Hospital mortality (%) | NA | 20.7% (237/1,146) | 7.0% (1324/18,843) | NA | 7.8% (1567/20,064) |
aP < .05; bP < .01; cP < .001 bivariate correlations compared to the pre-SARS-CoV-2 period
dIncludes the following baseline conditions occurring within the first 3 days of hospital admissions as determined by the maximum value of surrogate laboratory results: renal insufficiency (serum creatinine [SCr] > 2.0 mg/dL [to convert to micromoles per liter, multiply by 88.4]); kidney failure (blood urea nitrogen > 100 and SCr > 3.0 mg/dL); suspected sepsis (lactic acid > 2.0 or > 4.0 mmol/L); suspected heart failure (brain-type natriuretic peptide [BNP] > 400 pg/mL [to convert to nanograms per liter, multiply by 1.0] or N-terminal pro BNP > 900 pg/mL); myocardial inflammation (doubling of troponin drawn within 6 h final value: troponin 0.4 ng/L [to convert to micrograms per liter, multiply by 1.0], troponin T15 ng/L [to convert to micrograms per liter, multiply by 1.0] in male patients, troponin T10 ng/L in female patients, troponin I > 0.04 ng/mL [to convert to micrograms per liter, multiply by 1.0]); liver dysfunction (any of the following: alanine aminotransferase > 60 U/L [to convert to microkatals per liter, multiply by 0.0167], aspartate aminotransferase > 80 U/L [to convert to microkatals per liter, multiply by 0.0167], serum albumin < 3.0 g/dL [to convert to grams per liter, multiply by 10], international normalized ratio > 2.0 [and not currently receiving warfarin, rivaroxaban, apixaban, edoxaban, or betrixaban]); cytokine stimulation (any of the following: fibrinogen < 250 mg/dL [to convert to grams per liter, multiply by 0.01], C-reactive protein > 7.0 mg/dL [to convert to milligrams per liter, multiply by 10], D-dimer [dimerized plasmin fragment D] > 1000 ng/mL [to convert to nanomoles per liter, multiply by 5.476], erythrocyte sedimentation rate > 30 mm/h, or triglycerides > 265 mg/dL [to convert to millimoles per liter, multiply by 0.0113])
eThe patient was (a) started on intravenous (IV)/IV push (IVP) sedation medications (propofol, lorazepam, midazolam, dexmedetomidine, or ketamine) or IV/IVP opioids (fentanyl, remifentanil, sufentanil, or hydromorphone) with a duration ≥ 24 h and (b) ≥ 2 arterial blood gas results collected ≥ 24 h apart (on the first day of sedation medication and a subsequent result 24 h later)