(HealthDay)—Hospitalized COVID-19 patients cared for in hospitals with the greatest surges in caseload have twofold greater mortality risk than patients in hospitals not experiencing surges, according to a study published online July 6 in the Annals of Internal Medicine.

Sameer S. Kadri, M.D., from the National Institutes of Health Clinical Center in Bethesda, Maryland, and colleagues evaluated the association between hospitals’ severity-weighted COVID-19 caseload and COVID-19 mortality risk. The analysis included adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020.

The researchers found that of the 144,116 inpatients with COVID-19 at 558 U.S. hospitals, 54.2 percent were admitted to hospitals in the top surge index decile and, overall, 17.6 percent of patients died. Crude COVID-19 mortality decreased over time across all surge index strata, but the risk for death increased in the 50 to 75, 75 to 90, 90 to 95, 95 to 99, and >99 percentiles (odds ratios, 1.11, 1.24, 1.42, 1.59, and 2.00, respectively) compared with nonsurging (<50th surge index percentile) hospital-months. The association between surge index and mortality was visible across ward, intensive care unit, and intubated patients. Despite greater corticosteroid use and more judicious intubation during later and higher-surging months, the surge-mortality relationship was stronger in June to August than in March to May. It is estimated that nearly one in four COVID-19 deaths (23.2 percent) were potentially attributable to hospitals strained by surging caseload.

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