TY - JOUR
T1 - Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic
T2 - an analysis of the prospective, international, multicentre RISC-19-ICU registry
AU - Wendel-Garcia, Pedro David
AU - Moser, André
AU - Jeitziner, Marie-Madlen
AU - Aguirre-Bermeo, Hernán
AU - Arias-Sanchez, Pedro
AU - Apolo, Janina
AU - Roche-Campo, Ferran
AU - Franch-Llasat, Diego
AU - Kleger, Gian-Reto
AU - Schrag, Claudia
AU - Pietsch, Urs
AU - Filipovic, Miodrag
AU - David, Sascha
AU - Stahl, Klaus
AU - Bouaoud, Souad
AU - Ouyahia, Amel
AU - Fodor, Patricia
AU - Locher, Pascal
AU - Siegemund, Martin
AU - Zellweger, Nuria
AU - Cereghetti, Sara
AU - Schott, Peter
AU - Gangitano, Gianfilippo
AU - Wu, Maddalena Alessandra
AU - Alfaro-Farias, Mario
AU - Vizmanos-Lamotte, Gerardo
AU - Ksouri, Hatem
AU - Gehring, Nadine
AU - Rezoagli, Emanuele
AU - Turrini, Fabrizio
AU - Lozano-Gómez, Herminia
AU - Carsetti, Andrea
AU - Rodríguez-García, Raquel
AU - Yuen, Bernd
AU - Weber, Anja Baltussen
AU - Castro, Pedro
AU - Escos-Orta, Jesus Oscar
AU - Dullenkopf, Alexander
AU - Martín-Delgado, Maria C.
AU - Aslanidis, Theodoros
AU - Perez, Marie-Helene
AU - Hillgaertner, Frank
AU - Ceruti, Samuele
AU - Franchitti Laurent, Marilene
AU - Marrel, Julien
AU - Colombo, Riccardo
AU - Laube, Marcus
AU - Montomoli, Jonathan
AU - Guerci, Philippe
AU - RISC-19-ICU Investigators
AU - Hilty, Matthias Peter
N1 - Publisher Copyright: © 2022. The Author(s).
PY - 2022/7/4
Y1 - 2022/7/4
N2 - 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.
AB - 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.
KW - ARDS
KW - COVID-19
KW - Disease dynamics
KW - Intensive care unit
KW - Pandemic
UR - http://www.scopus.com/inward/record.url?scp=85133228424&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13054-022-04065-2
DO - https://doi.org/10.1186/s13054-022-04065-2
M3 - Article
C2 - 35787726
SN - 1364-8535
VL - 26
SP - 199
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
ER -