COVID-19: Important Updates and Developments Edited by Franco Rongioletti, MD, and Leonard J. Hoenig, MD| Volume 39, ISSUE 3, P510-516, May 01, 2021

“Do-not-resuscitate (DNR)” status determines mortality in patients with COVID-19


      We investigatd the influence of do-not-resuscitate (DNR) status on mortality of hospital inpatients who died of COVID-19. 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%] with and 70 [10.9%] without a DNR order at the time of admission) and 630 survived (180 [28.6%] with and 450 [71.4%] without a DNR order when admitted). Among the 120 patients without COVID-19 who died during this interval, 110 (91.7%) had a DNR order when admitted. Deceased positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients were significantly more likely to have a DNR order on admission compared with 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 with 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 with non-DNR patients, a finding that remained significant in the multivariate model. The risk of death from COVID-19 was significantly influenced by the patients’ DNR status.
      To read this article in full you will need to make a payment


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Coronavirus Resource Center. Available at: Accessed August 25, 2020.

        • Loertscher L.
        • Reed D.A.
        • Bannon M.P.
        • Mueller P.S.
        Cardiopulmonary resuscitation and do-not-resuscitate orders: a guide for clinicians.
        Am J Med. 2010; 123: 4-9
        • Burns J.P.
        • Edwards J.
        • Johnson J.
        • Cassem N.H.
        • Truog R.D.
        Do-not-resuscitate order after 25 years.
        Crit Care Med. 2003; 31: 1543-1550
        • Brovman E.Y.
        • Walsh E.C.
        • Burton B.N.
        • et al.
        Postoperative outcomes in patients with a do-not-resuscitate (DNR) order undergoing elective procedures.
        J Clin Anesth. 2018; 48: 81-88
        • DeFilippis E.M.
        • Ranard L.S.
        • Berg D.D.
        Cardiopulmonary resuscitation during the COVID-19 pandemic: A view from trainees on the front line.
        Circulation. 2020; 141: 1833-1835
        • Curtis J.R.
        • Kross E.K.
        • Stapleton R.D.
        The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19).
        JAMA. 2020; 323: 1771-1772
      2. Centers for Disease Control and Prevention. Reporting and coding deaths due to COVID-19. Available at: Accessed August 25, 2020.

        • Fried T.R.
        • Bradley E.H.
        • Towle V.R.
        • Allore H.
        Understanding the treatment preferences of seriously ill patients.
        N Engl J Med. 2002; 346: 1061-1066
      3. Richardson S., Hirsch J.S., Narasimhan M., et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA.2020;323:2050-2059; Correction: JAMA. 2020;323:2098.

        • Curtis J.R.
        • Mirarchi F.L.
        The importance of clarity for hospital code status orders: Challenges and opportunities.
        Chest. 2020; 158: 21-23