ICU strain and outcome in COVID-19 patients-A multicenter retrospective observational study
Alexandre Demoule1,2, Muriel Fartoukh3,4, Guillaume Louis5
1Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.
Insights
Intensive care unit (ICU) strain, not the pandemic wave, independently predicted 28-day mortality in coronavirus disease (COVID)-19 patients. Management strategies evolved between waves, but overall mortality remained similar.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- The coronavirus disease (COVID)-19 pandemic presented unprecedented challenges to intensive care units (ICUs).
- Understanding patient characteristics, management, and outcomes across different phases of the pandemic is crucial for optimizing critical care.
- Evaluating the impact of ICU strain on patient mortality is essential for resource allocation and public health strategies.
Purpose of the Study:
- To compare characteristics, management, and prognosis of COVID-19 patients in ICUs during the first two pandemic waves.
- To assess the relationship between ICU strain and mortality in COVID-19 patients.
Main Methods:
- A multicentre retrospective study included 1166 COVID-19 patients admitted to five French ICUs from February to December 2020.
- Data were collected from medical records, and a Cox proportional-hazards model was used to identify factors associated with 28-day mortality.
- ICU strain was calculated based on COVID-19 admissions relative to each center's mean admission rate.
Main Results:
- Patient demographics and management differed between the first and second waves, with second-wave patients being older, having more severe hypoxemia, and receiving less frequent intubation.
- High flow nasal cannula use increased significantly in the second wave.
- Neither 28-day nor hospital mortality rates differed significantly between the two waves. Overweight/obesity correlated with lower 28-day mortality, while older age, chronic kidney disease, higher SOFA scores, and ICU strain were associated with increased 28-day mortality.
Conclusions:
- Patient characteristics and management strategies evolved between the first and second COVID-19 waves.
- ICU strain, rather than the pandemic wave itself, was independently associated with 28-day mortality.
- ICU strain did not show an association with hospital mortality.
Purpose:
To compare the characteristics, management, and prognosis of patients admitted to intensive care units (ICU) for coronavirus disease (COVID)-19 during the first two waves of the outbreak and to evaluate the relationship between ICU strain (ICU demand due to COVID-19 admissions) and mortality.
Methods:
In a multicentre retrospective study, 1166 COVID-19 patients admitted to five ICUs in France between 20 February and 31 December 2020 were included. Data were collected at each ICU from medical records. A Cox proportional-hazards model identified factors associated with 28-day mortality.
Results:
640 patients (55%) were admitted during the first wave (February to June 2020) and 526 (45%) during the second wave (July to December 2020). ICU strain was lower during the second wave (-0.81 [-1.04 --0.31] vs. 1.18 [-0.34-1.29] SD when compared to mean COVID-19 admission in each center during study period, P<0.001). Patients admitted during the second wave were older, had more profound hypoxemia and lower SOFA. High flow nasal cannula was more frequently used during the second wave (68% vs. 39%, P<0.001) and intubation was less frequent (46% vs. 69%, P<0.001). Neither 28-day mortality (30% vs. 26%, P = 0.12) nor hospital mortality (37% vs. 31%, P = 0.27) differed between first and second wave. Overweight and obesity were associated with lower 28-day mortality while older age, underlying chronic kidney disease, severity at ICU admission as assessed by SOFA score and ICU strain were associated with higher 28-day mortality. ICU strain was not associated with hospital mortality.
Conclusion:
The characteristics and the management of patients varied between the first and the second wave of the pandemic. Rather than the wave, ICU strain was independently associated with 28-day mortality, but not with hospital mortality.
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