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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State: Public
Version: author
License: CC BY 4.0
Serval ID
serval:BIB_DFA97D87795C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
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.
Journal
Critical care
Working group(s)
RISC-19-ICU Investigators
Contributor(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
Publication state
Published
Issued date
04/07/2022
Peer-reviewed
Oui
Volume
26
Number
1
Pages
199
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: epublish
Publication Status: epublish
Abstract
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.
Keywords
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
Yes
Create date
12/07/2022 10:13
Last modification date
07/03/2023 6:48
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