tetano
Editor, Senior Moderator
J Infect
. 2023 May 16;S0163-4453(23)00289-X.
doi: 10.1016/j.jinf.2023.05.011. Online ahead of print. Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: a national database study
Diane Naouri[SUP] 1 [/SUP], Tai Pham[SUP] 2 [/SUP], Martin Dres[SUP] 3 [/SUP], Albert Vuagnat[SUP] 4 [/SUP], Gaëtan Beduneau[SUP] 5 [/SUP], Alain Mercat[SUP] 6 [/SUP], Alain Combes[SUP] 7 [/SUP], Antoine Kimmoun[SUP] 8 [/SUP], Matthieu Schmidt[SUP] 7 [/SUP], Alexandre Demoule[SUP] 3 [/SUP], Matthieu Jamme[SUP] 9 [/SUP]
Affiliations
Objective: Prior to the coronavirus disease 2019 (COVID-19) pandemic, influenza was the most frequent cause of viral respiratory pneumonia requiring intensive care unit (ICU) admission. Few studies have compared the characteristics and outcomes of critically ill patients with COVID-19 and influenza.
Methods: This was a French nationwide study comparing COVID-19 (March 1, 2020-June 30, 2021) and influenza patients (January 1, 2014-December 31, 2019) admitted to an ICU during pre-vaccination era. Primary outcome was in-hospital death. Secondary outcome was need for mechanical ventilation.
Results: 105,979 COVID-19 patients were compared to 18,763 influenza patients. Critically ill patients with COVID-19 were more likely to be men with more comorbidities. Patients with influenza required more invasive mechanical ventilation (47 vs. 34%, p<0·001), vasopressors (40% vs. 27, p<0·001) and renal-replacement therapy (22 vs. 7%, p<0·001). Hospital mortality was 25 and 21% (p<0·001) in patients with COVID-19 and influenza, respectively. In the subgroup of patients receiving invasive mechanical ventilation, ICU length of stay was significantly longer in patients with COVID-19 (18 [10-32] vs. 15 [8-26] days, p<0·001). Adjusting for age, gender, comorbidities, and modified SAPS II score, in-hospital death was higher in COVID-19 patients (adjusted sub-distribution hazard ratio [aSHR]=1.69; 95%CI=1.63-1.75) compared with influenza patients. COVID-19 was also associated with less invasive mechanical ventilation (aSHR=0.87; 95%CI=0.85-0.89) and a higher likelihood of death without invasive mechanical ventilation (aSHR=2.40; 95%CI=2.24-2.57).
Conclusion: Despite younger age and lower SAPS II score, critically ill COVID-19 patients had a longer hospital stay and higher mortality than patients with influenza.
Keywords: COVID-19; Influenzae; Intensive care unit; Nationwide study.
. 2023 May 16;S0163-4453(23)00289-X.
doi: 10.1016/j.jinf.2023.05.011. Online ahead of print. Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: a national database study
Diane Naouri[SUP] 1 [/SUP], Tai Pham[SUP] 2 [/SUP], Martin Dres[SUP] 3 [/SUP], Albert Vuagnat[SUP] 4 [/SUP], Gaëtan Beduneau[SUP] 5 [/SUP], Alain Mercat[SUP] 6 [/SUP], Alain Combes[SUP] 7 [/SUP], Antoine Kimmoun[SUP] 8 [/SUP], Matthieu Schmidt[SUP] 7 [/SUP], Alexandre Demoule[SUP] 3 [/SUP], Matthieu Jamme[SUP] 9 [/SUP]
Affiliations
- PMID: 37201858
- DOI: 10.1016/j.jinf.2023.05.011
Objective: Prior to the coronavirus disease 2019 (COVID-19) pandemic, influenza was the most frequent cause of viral respiratory pneumonia requiring intensive care unit (ICU) admission. Few studies have compared the characteristics and outcomes of critically ill patients with COVID-19 and influenza.
Methods: This was a French nationwide study comparing COVID-19 (March 1, 2020-June 30, 2021) and influenza patients (January 1, 2014-December 31, 2019) admitted to an ICU during pre-vaccination era. Primary outcome was in-hospital death. Secondary outcome was need for mechanical ventilation.
Results: 105,979 COVID-19 patients were compared to 18,763 influenza patients. Critically ill patients with COVID-19 were more likely to be men with more comorbidities. Patients with influenza required more invasive mechanical ventilation (47 vs. 34%, p<0·001), vasopressors (40% vs. 27, p<0·001) and renal-replacement therapy (22 vs. 7%, p<0·001). Hospital mortality was 25 and 21% (p<0·001) in patients with COVID-19 and influenza, respectively. In the subgroup of patients receiving invasive mechanical ventilation, ICU length of stay was significantly longer in patients with COVID-19 (18 [10-32] vs. 15 [8-26] days, p<0·001). Adjusting for age, gender, comorbidities, and modified SAPS II score, in-hospital death was higher in COVID-19 patients (adjusted sub-distribution hazard ratio [aSHR]=1.69; 95%CI=1.63-1.75) compared with influenza patients. COVID-19 was also associated with less invasive mechanical ventilation (aSHR=0.87; 95%CI=0.85-0.89) and a higher likelihood of death without invasive mechanical ventilation (aSHR=2.40; 95%CI=2.24-2.57).
Conclusion: Despite younger age and lower SAPS II score, critically ill COVID-19 patients had a longer hospital stay and higher mortality than patients with influenza.
Keywords: COVID-19; Influenzae; Intensive care unit; Nationwide study.