Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year.
Acute kidney injury
Elderly
Mechanical ventilation
SARS-CoV‑2
Second wave
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
28
06
2021
accepted:
25
08
2021
pubmed:
19
10
2021
medline:
17
12
2021
entrez:
18
10
2021
Statut:
ppublish
Résumé
Widely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients. This multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic. Overall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54-74 years vs. 72 years, IQR 62-78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5-18 days vs. 18 days, IQR 5-31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort. Advanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.
Sections du résumé
BACKGROUND
BACKGROUND
Widely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients.
METHODS
METHODS
This multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic.
RESULTS
RESULTS
Overall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54-74 years vs. 72 years, IQR 62-78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5-18 days vs. 18 days, IQR 5-31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort.
CONCLUSION
CONCLUSIONS
Advanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.
Identifiants
pubmed: 34661740
doi: 10.1007/s00508-021-01945-5
pii: 10.1007/s00508-021-01945-5
pmc: PMC8521508
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1237-1247Informations de copyright
© 2021. The Author(s).
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Lancet Respir Med. 2021 May;9(5):e47-e48
pubmed: 33684356
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Wien Klin Wochenschr. 2020 Nov;132(21-22):653-663
pubmed: 33170333
Nat Rev Nephrol. 2020 Dec;16(12):747-764
pubmed: 33060844
JAMA. 2020 Oct 6;324(13):1307-1316
pubmed: 32876695
Crit Care Med. 2021 Jan 1;49(1):102-111
pubmed: 33116052
Dtsch Arztebl Int. 2020 Aug 3;117(31-32):528-533
pubmed: 32900426
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Crit Care. 2021 Jan 4;25(1):3
pubmed: 33397421
Crit Care. 2013 May 27;17(3):R98
pubmed: 23710662
Anaesthesia. 2020 Oct;75(10):1340-1349
pubmed: 32602561
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Lancet Respir Med. 2020 Sep;8(9):853-862
pubmed: 32735842
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Lancet Respir Med. 2020 Oct;8(10):952-953
pubmed: 32835653
Crit Care. 2021 Apr 19;25(1):149
pubmed: 33874987
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
Lancet Reg Health Eur. 2021 May;4:100054
pubmed: 33997829
Nephron Clin Pract. 2012;120(4):c179-84
pubmed: 22890468
Intensive Care Med. 2020 Nov;46(11):2035-2047
pubmed: 33034689
Crit Care. 2017 Jul 12;21(1):184
pubmed: 28701227
Intensive Care Med. 2020 Apr;46(4):654-672
pubmed: 31820034
Intensive Care Med. 2021 May;47(5):538-548
pubmed: 33852032
BMC Infect Dis. 2020 Aug 31;20(1):640
pubmed: 32867706