'Do-Not-Resuscitate (DNR)' Status Determines Mortality in Patients with COVID-19

 AlbertAlhatemMDaOdetteSpruijtMBChB, FRACP, FRAChPMbDebra S.HellerMDaRavi J.ChokshiMD, MPHcRobert ASchwartzMD, MPH, DSc (Hon), FRCP EdinadW.ClarkLambertMD. PhDad

DOI: https://doi.org/10.1016/j.clindermatol.2020.11.013

PDF: https://www.sciencedirect.com/science/article/pii/S0738081X20302315/pdfft?md5=951a468e348daf476fbb314eae7c9140&pid=1-s2.0-S0738081X20302315-main.pdf

ABSTRACT

Objective

To investigate the influence of DNR status on mortality of hospital inpatients who died of COVID-19.

Design

This is a retrospective, observational cohort study of all patients admitted to two New Jersey hospitals between March 15 and May 15, 2020 who had, or developed, COVID-19 (1270 patients). Of these, 640 patients died (570 (89.1 percent) with and 70 (10.9 percent) without a DNR order at the time of admission) and 630 survived (180 (28.6 percent) with and 450 (71.4 percent) without a DNR order when admitted). Among the 120 patients without COVID-19 who died during this interval, 110 (91.7 percent) had a DNR order when admitted.

Results

Deceased positive SARS-CoV-2 patients were significantly more likely to have a DNR order on admission compared to recovered positive SARS-COV-2 patients (p < 0.05), similar to those who tested negative for SARS-COV-2. COVID-19 DNR patients had a higher mortality compared to COVID-19 non-DNR patients (log rank p < 0.001). DNR patients had a significantly increased hazard ratio of dying (HR 2.2 [1.5-3.2], p <0.001) compared to non-DNR patients, a finding that remained significant in the multivariate model.

Conclusion

The risk of death from COVID-19 was significantly influenced by the patients’ DNR status.

https://www.sciencedirect.com/science/article/pii/S0738081X20302315