Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry.
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BORIS DOI
Date of Publication
July 4, 2022
Publication Type
Article
Division/Institute
Author
Wendel-Garcia, Pedro David | |
Aguirre-Bermeo, Hernán | |
Arias-Sanchez, Pedro | |
Apolo, Janina | |
Roche-Campo, Ferran | |
Franch-Llasat, Diego | |
Kleger, Gian-Reto | |
Schrag, Claudia | |
Pietsch, Urs | |
Filipovic, Miodrag | |
David, Sascha | |
Stahl, Klaus | |
Bouaoud, Souad | |
Ouyahia, Amel | |
Fodor, Patricia | |
Locher, Pascal | |
Siegemund, Martin | |
Zellweger, Nuria | |
Cereghetti, Sara | |
Schott, Peter | |
Gangitano, Gianfilippo | |
Wu, Maddalena Alessandra | |
Alfaro-Farias, Mario | |
Vizmanos-Lamotte, Gerardo | |
Ksouri, Hatem | |
Gehring, Nadine | |
Rezoagli, Emanuele | |
Turrini, Fabrizio | |
Lozano-Gómez, Herminia | |
Carsetti, Andrea | |
Rodríguez-García, Raquel | |
Yuen, Bernd | |
Weber, Anja Baltussen | |
Castro, Pedro | |
Escos-Orta, Jesus Oscar | |
Dullenkopf, Alexander | |
Martín-Delgado, Maria C | |
Aslanidis, Theodoros | |
Perez, Marie-Helene | |
Hillgaertner, Frank | |
Ceruti, Samuele | |
Franchitti Laurent, Marilene | |
Marrel, Julien | |
Colombo, Riccardo | |
Laube, Marcus | |
Fogagnolo, Alberto | |
Studhalter, Michael | |
Wengenmayer, Tobias | |
Gamberini, Emiliano | |
Buerkle, Christian | |
Buehler, Philipp K | |
Keiser, Stefanie | |
Elhadi, Muhammed | |
Montomoli, Jonathan | |
Guerci, Philippe | |
Fumeaux, Thierry | |
Schuepbach, Reto A | |
Que, Yok-Ai | |
Hilty, Matthias Peter |
Subject(s)
Series
Critical care (London, England)
ISSN or ISBN (if monograph)
1466-609X
Publisher
BMC
Language
English
Publisher DOI
PubMed ID
35787726
Uncontrolled Keywords
Description
BACKGROUND
It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.
METHODS
Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.
RESULTS
Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic.
CONCLUSION
Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.
It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.
METHODS
Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.
RESULTS
Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic.
CONCLUSION
Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.
File(s)
File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
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s13054-022-04065-2.pdf | text | Adobe PDF | 2.76 MB | Attribution (CC BY 4.0) | published |