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Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Rocheleau G, Russell JA. Organ dysfunction and death in patients admitted to hospital with COVID-19 in pandemic waves 1 to 3 in British Columbia, Ontario and Quebec, Canada: a cohort study. CMAJ Open 2022; 10:E379-E389. [PMID: 35440485 PMCID: PMC9022939 DOI: 10.9778/cmajo.20210216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated β regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04510623.
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Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - François Lamontagne
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Maslove
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Genevieve Rocheleau
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
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