Corrêa Thiago Domingos, Midega Thais Dias, Nawa Ricardo Kenji, Cordioli Ricardo Luiz, Pereira Adriano José, Silva Júnior Moacyr, Bravim Bruno de Arruda, Campos Niklas Soderberg, Felicio Amanda Pascoal Valle, Carvalho Angelo Antônio Gomes de, Pardini Andreia, Eid Raquel Afonso Caserta, Rodrigues Rodrigo Dias, Pesavento Marcele Liliane, Andari Leonardo Van de Wiel Barros Urbano, Santos Bento Fortunato Cardoso Dos, Laselva Claudia Regina, Piza Felipe Maia de Toledo, Cendoroglo Neto Miguel, Schettino Guilherme de Paula Pinto, Klajner Sidney, Ferraz Leonardo José Rolim
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Department of Critical Care Medicine, Hospital Municipal Dr. Moysés Deutsch;Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2025 Mar 24;23(spe1):eAO1060. doi: 10.31744/einstein_journal/2025AO1060. eCollection 2025.
This retrospective multicenter cohort study compared characteristics and outcomes of 5,790 critically ill patients with COVID-19 in Brazil's public and private intensive care units. Patients in public intensive care units exhibited greater disease severity, more frequent use of organ support, and higher mortality rates compared to those in private intensive care units. The risk of in-hospital death was more than twice as high in public intensive care units. ■ Public intensive care unit COVID-19 patients presented with more comorbidities and higher severity at admission. ■ Public intensive care units required more invasive organ support (e.g., mechanical ventilation, vasopressors, and renal replacement therapy) but less non-invasive ventilation and high-flow nasal cannula than private intensive care units. ■ In-hospital mortality was higher in public intensive care units, with an increased risk of death even after adjusting for patient characteristics and illness severity at intensive care unit admission.
To compare the clinical characteristics, use of organ support, and outcomes of critically ill patients with COVID-19 admitted to public and private intensive care units.
This multicenter retrospective cohort study included patients admitted to four intensive care units from March 1, 2020, to December 31, 2021. Patients with COVID-19 admitted to public and private intensive care units were compared. The primary outcome of interest, in-hospital mortality, was assessed using a hierarchical logistic regression (multilevel) model adjusted for study site and patient characteristics.
A total of 5,790 patients with COVID-19 were admitted to the participating intensive care units, with 3,321 (57.3%) admitted to private hospitals and 2,469 (42.6%) admitted to public hospitals. Patients in public intensive care units were less likely to be male and had higher median SAPS III scores, Charlson Comorbidity Index values, and SOFA scores. They also required mechanical ventilation (53.1% versus 40.0%, p<0.001), vasopressors (43.1% versus 33.9%, p<0.001), and renal replacement therapy (20.3% versus. 14.5%, p<0.001) more frequently than those in private intensive care units. In contrast, patients in private intensive care units were more frequently managed with non-invasive ventilation (38.0% versus 66.8%; p<0.001) and high-flow nasal cannulas (18.3% versus 48.1%; p<0.001). The in-hospital mortality rate was significantly higher in public intensive care units (40.3%) compared to private intensive care units (16.4%) (adjusted OR=2.96; 95%CI=1.94-4.51; p<0.001).
We observed significant differences in resource utilization and mortality rates between patients with COVID-19 admitted to public and private intensive care units. Patients with COVID-19 in public care units face a higher risk of in-hospital mortality compared to those in private care units.
这项回顾性多中心队列研究比较了巴西公立和私立重症监护病房中5790例新冠肺炎危重症患者的特征和结局。与私立重症监护病房的患者相比，公立重症监护病房的患者疾病严重程度更高，器官支持的使用更频繁，死亡率也更高。公立重症监护病房的院内死亡风险是私立重症监护病房的两倍多。
公立重症监护病房的新冠肺炎患者入院时合并症更多，病情更严重。
与私立重症监护病房相比，公立重症监护病房需要更多的有创器官支持（如机械通气、血管活性药物和肾脏替代治疗），但无创通气和高流量鼻导管的使用较少。
公立重症监护病房的院内死亡率更高，即使在对患者特征和重症监护病房入院时的疾病严重程度进行调整后，死亡风险仍然增加。
比较入住公立和私立重症监护病房的新冠肺炎危重症患者的临床特征、器官支持的使用情况和结局。
这项多中心回顾性队列研究纳入了2020年3月1日至2021年12月31日期间入住四个重症监护病房的患者。对入住公立和私立重症监护病房的新冠肺炎患者进行了比较。使用分层逻辑回归（多级）模型对研究地点和患者特征进行调整，评估主要关注结局——院内死亡率。
共有5790例新冠肺炎患者入住参与研究的重症监护病房，其中3321例（57.3%）入住私立医院，2469例（42.6%）入住公立医院。公立重症监护病房的患者男性比例较低，其简化急性生理学评分III（SAPS III）、查尔森合并症指数和序贯器官衰竭评估（SOFA）评分的中位数较高。与私立重症监护病房的患者相比，他们也更频繁地需要机械通气（53.1%对40.0%，p<0.001）、血管活性药物（43.1%对33.9%，p<0.001）和肾脏替代治疗（20.3%对14.
