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.
Détails
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Etat: Public
Version: de l'auteur⸱e
Licence: CC BY 4.0
ID Serval
serval:BIB_DFA97D87795C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
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.
Périodique
Critical care
Collaborateur⸱rice⸱s
RISC-19-ICU Investigators
Contributeur⸱rice⸱s
Hilty M.P., Wendel-Garcia P., Schuepbach R.A., Montomoli J., Guerci P., Fumeaux T., Bouaoud S., Ouyahia A., Abdoun M., Rais M., Alfaro-Farias M., Vizmanos-Lamotte G., Caballero A., Tschoellitsch T., Meier J., Aguirre-Bermeo H., Arias-Sanchez P., Apolo J., Martinez L.A., Tirapé-Castro H., Galal I., Tharwat S., Abdehaleem I., Jurkolow G., Guerci P., Novy E., Losser M.R., Wengenmayer T., Zotzmann V., David S., Stahl K., Seeliger B., Welte T., Aslanidis T., Korsos A., Ahmed L.A., Hashim H.T., Nikandish R., Carsetti A., Casarotta E., Giaccaglia P., Rezoagli E., Giacomini M., Magliocca A., Bolondi G., Potalivo A., Fogagnolo A., Salvi L., Wu M.A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M.S., Fabbri S., Montomoli J., Gamberini E., Gangitano G., Bitondo M.M., Maciopinto F., de Camillis E., Venturi M., Bocci M.G., Antonelli M., Alansari A., Abusalama A., Omar O., Binnawara M., Alameen H., Elhadi M., Alhadi A., Arhaym A., Gommers D., Ince C., Jayyab M., Alsharif M., Rodríguez-García R., Gámez-Zapata J., Taboada-Fraga X., Castro P., Fernandez J., Reverter E., Lander-Azcona A., Escós-Orta J., Martín-Delgado M.C., Algaba-Calderon A., Roche-Campo F., Franch-Llasat D., Concha P., Sauras-Colón E., Lozano-Gómez H., Zalba-Etayo B., Montes M.P., Michot M.P., Klarer A., Ensner R., Schott P., Urech S., Siegemund M., Zellweger N., Gebhard C.E., Hollinger A., Merki L., Lambert A., Laube M., Jeitziner M.M., Moser A., Que Y.A., Jakob S.M., Wiegand J., Yuen B., Lienhardt-Nobbe B., Westphalen A., Salomon P., Hillgaertner F., Sieber M., Dullenkopf A., Barana G., Ksouri H., Sridharan G.O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Bürkle C., Marrel J., Brenni M., Fleisch I., Perez M.H., Ramelet A.S., Weber A.B., Gerecke P., Christ A., Ceruti S., Glotta A., Biggiogero M., Marquardt K., Hübner T., Neff T., Redecker H., Fumeaux T., Moret-Bochatay M., Betello M., Zu Bentrup F.M., Studhalter M., Stephan M., Gehring N., Selz D., Kleger G.R., Schrag C., Pietsch U., Filipovic M., Ristic A., Heise A., Franchitti Laurent M., Laurent J.C., Gaspert T., Haberthuer C., Fodor P., Locher P., Garcia PDW, Hilty M.P., Schuepbach R., Keiser S., Heuberger D., Bartussek J., Bühler P., Brugger S., Kleinert E.M., Fehlbier K.J., Danial A., Almousa M., Abdulbaki Y., Sannah K., Colak E., Marczin N., Al-Ameri S.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Statut éditorial
Publié
Date de publication
04/07/2022
Peer-reviewed
Oui
Volume
26
Numéro
1
Pages
199
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: epublish
Publication Status: epublish
Résumé
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.
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.
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 PaO <sub>2</sub> /FiO <sub>2</sub> 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.
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.
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.
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 PaO <sub>2</sub> /FiO <sub>2</sub> 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.
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.
Mots-clé
COVID-19/therapy, Critical Illness/epidemiology, Critical Illness/therapy, Female, Humans, Intensive Care Units, Middle Aged, Pandemics, Prospective Studies, Registries, ARDS, COVID-19, Disease dynamics, Intensive care unit, Pandemic
Pubmed
Web of science
Open Access
Oui
Création de la notice
12/07/2022 11:13
Dernière modification de la notice
07/03/2023 7:48
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