TY - JOUR
T1 - Characteristics and outcome of COVID-19 patients admitted to the ICU
T2 - a nationwide cohort study on the comparison between the consecutive stages of the COVID-19 pandemic in the Netherlands, an update
AU - Termorshuizen, Fabian
AU - Dongelmans, Dave A.
AU - Brinkman, Sylvia
AU - Bakhshi-Raiez, Ferishta
AU - Arbous, M. Sesmu
AU - de Lange, Dylan W.
AU - van Bussel, Bas C.T.
AU - de Keizer, Nicolette F.
N1 - Funding Information: We would like to acknowledge the effort of all Dutch hospitals to record their COVID-19 patients daily and additionally all the ICUs that also collected the comprehensive clinical data of the COVID-19 patients to NICE-DB. Without their effort this study would not have been possible. We also like to thank all employees of NICE Research & Support for the technical development of the COVID-19 Online Module, processing the data, and support under high work pressure. Funding Information: This research was funded by The Netherlands Organisation for Health Research and Development (ZonMw) COVID-19 Programme in the bottom-up focus area 1 “Predictive diagnostics and treatment” for theme 3 “Risk analysis and prognostics” (project number 10430 01 201 0011: IRIS). The funder had no role in the design of the study or in the writing of the manuscript. Publisher Copyright: © 2024, The Author(s).
PY - 2024/12
Y1 - 2024/12
N2 - Background: Previously, we reported a decreased mortality rate among patients with COVID-19 who were admitted at the ICU during the final upsurge of the second wave (February–June 2021) in the Netherlands. We examined whether this decrease persisted during the third wave and the phases with decreasing incidence of COVID-19 thereafter and brought up to date the information on patient characteristics. Methods: Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and rates of in-hospital mortality (the primary outcome) during the consecutive periods after the first wave (periods 2–9, May 25, 2020–January 31, 2023) were compared with those during the first wave (period 1, February–May 24, 2020). Results: After adjustment for patient characteristics and ICU occupancy rate, the mortality risk during the initial upsurge of the third wave (period 6, October 5, 2021–January, 31, 2022) was similar to that of the first wave (ORadj = 1.01, 95%-CI [0.88–1.16]). The mortality rates thereafter decreased again (e.g., period 9, October 5, 2022–January, 31, 2023: ORadj = 0.52, 95%-CI [0.41–0.66]). Among the SARS-CoV-2 positive patients, there was a huge drop in the proportion of patients with COVID-19 as main reason for ICU admission: from 88.2% during the initial upsurge of the third wave to 51.7%, 37.3%, and 41.9% for the periods thereafter. Restricting the analysis to these patients did not modify the results on mortality. Conclusions: The results show variation in mortality rates among critically ill COVID-19 patients across the calendar time periods that is not explained by differences in case-mix and ICU occupancy rates or by varying proportions of patients with COVID-19 as main reason for ICU admission. The consistent increase in mortality during the initial, rising phase of each separate wave might be caused by the increased virulence of the contemporary virus strain and lacking immunity to the new strain, besides unmeasured patient-, treatment- and healthcare system characteristics.
AB - Background: Previously, we reported a decreased mortality rate among patients with COVID-19 who were admitted at the ICU during the final upsurge of the second wave (February–June 2021) in the Netherlands. We examined whether this decrease persisted during the third wave and the phases with decreasing incidence of COVID-19 thereafter and brought up to date the information on patient characteristics. Methods: Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and rates of in-hospital mortality (the primary outcome) during the consecutive periods after the first wave (periods 2–9, May 25, 2020–January 31, 2023) were compared with those during the first wave (period 1, February–May 24, 2020). Results: After adjustment for patient characteristics and ICU occupancy rate, the mortality risk during the initial upsurge of the third wave (period 6, October 5, 2021–January, 31, 2022) was similar to that of the first wave (ORadj = 1.01, 95%-CI [0.88–1.16]). The mortality rates thereafter decreased again (e.g., period 9, October 5, 2022–January, 31, 2023: ORadj = 0.52, 95%-CI [0.41–0.66]). Among the SARS-CoV-2 positive patients, there was a huge drop in the proportion of patients with COVID-19 as main reason for ICU admission: from 88.2% during the initial upsurge of the third wave to 51.7%, 37.3%, and 41.9% for the periods thereafter. Restricting the analysis to these patients did not modify the results on mortality. Conclusions: The results show variation in mortality rates among critically ill COVID-19 patients across the calendar time periods that is not explained by differences in case-mix and ICU occupancy rates or by varying proportions of patients with COVID-19 as main reason for ICU admission. The consistent increase in mortality during the initial, rising phase of each separate wave might be caused by the increased virulence of the contemporary virus strain and lacking immunity to the new strain, besides unmeasured patient-, treatment- and healthcare system characteristics.
KW - COVID-19
KW - Coronavirus
KW - Critical Care
KW - Intensive Care
KW - Mortality
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85182421655&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13613-023-01238-2
DO - https://doi.org/10.1186/s13613-023-01238-2
M3 - Article
C2 - 38228972
SN - 2110-5820
VL - 14
JO - Annals of intensive care
JF - Annals of intensive care
IS - 1
M1 - 11
ER -