PT - JOURNAL ARTICLE AU - Luis Felipe Reyes AU - Srinivas Murthy AU - Esteban Garcia-Gallo AU - Mike Irvine AU - Laura Merson AU - Ignacio Martin-Loeches AU - Jordi Rello AU - Fabio S. Taccone AU - Robert A. Fowler AU - Annemarie B. Docherty AU - Christiana Kartsonaki AU - Irene Aragao AU - Peter W. Barrett AU - Abigail Beane AU - Aidan Burrell AU - Matthew Pellan Cheng AU - Michael D. Christian AU - Jose Pedro Cidade AU - Barbara Wanjiru Citarella AU - Christl A. Donnelly AU - Susana M. Fernandes AU - Craig French AU - Rashan Haniffa AU - Ewen M. Harrison AU - Antonia Ying Wai Ho AU - Mark Joseph AU - Irfan Khan AU - Michelle E. Kho AU - Anders Benjamin Kildal AU - Demetrios Kutsogiannis AU - François Lamontagne AU - Todd C. Lee AU - Gianluigi Li Bassi AU - Jose Wagner Lopez Revilla AU - Catherine Marquis AU - Jonathan Millar AU - Raul Neto AU - Alistair Nichol AU - Rachael Parke AU - Rui Pereira AU - Sergio Poli AU - Pedro Povoa AU - Kollengode Ramanathan AU - Oleksa Rewa AU - Jordi Riera AU - Sally Shrapnel AU - Maria Joao Silva AU - Andrew Udy AU - Timothy Uyeki AU - Steve A. Webb AU - Evert-Jan Wils AU - Amanda Rojek AU - Piero L. Olliaro ED - , AU - ISARIC Clinical Characterisation Group TI - Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study AID - 10.1183/23120541.00552-2021 DP - 2022 Jan 01 TA - ERJ Open Research PG - 00552-2021 VI - 8 IP - 1 4099 - http://openres.ersjournals.com/content/8/1/00552-2021.short 4100 - http://openres.ersjournals.com/content/8/1/00552-2021.full SO - erjor2022 Jan 01; 8 AB - Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU.Countries and hospitals need to identify strategies to increase their ICU capacity (i.e. trained personnel, ICU beds and monitoring systems) to treat patients presenting to the hospital with severe #COVID19 rather than provide such care outside of the ICU https://bit.ly/3xh9A6M