tetano
Editor, Senior Moderator
PLoS One
. 2022 Jul 19;17(7):e0271358.
doi: 10.1371/journal.pone.0271358. eCollection 2022.
ICU strain and outcome in COVID-19 patients-A multicenter retrospective observational study
Alexandre Demoule[SUP] 1 2 [/SUP], Muriel Fartoukh[SUP] 3 4 [/SUP], Guillaume Louis[SUP] 5 [/SUP], Elie Azoulay[SUP] 6 [/SUP], Safaa Nemlaghi[SUP] 1 [/SUP], Edouard Jullien[SUP] 7 [/SUP], Cyrielle Desnos[SUP] 3 4 [/SUP], Sebastien Clerc[SUP] 1 [/SUP], Elise Yvin[SUP] 6 [/SUP], Nouchan Mellati[SUP] 5 [/SUP], Cyril Charron[SUP] 7 [/SUP], Guillaume Voiriot[SUP] 3 4 [/SUP], Yoann Picard[SUP] 5 [/SUP], Antoine Vieillard-Baron[SUP] 7 8 [/SUP], Michael Darmon[SUP] 6 [/SUP]
Affiliations
Abstract
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.
. 2022 Jul 19;17(7):e0271358.
doi: 10.1371/journal.pone.0271358. eCollection 2022.
ICU strain and outcome in COVID-19 patients-A multicenter retrospective observational study
Alexandre Demoule[SUP] 1 2 [/SUP], Muriel Fartoukh[SUP] 3 4 [/SUP], Guillaume Louis[SUP] 5 [/SUP], Elie Azoulay[SUP] 6 [/SUP], Safaa Nemlaghi[SUP] 1 [/SUP], Edouard Jullien[SUP] 7 [/SUP], Cyrielle Desnos[SUP] 3 4 [/SUP], Sebastien Clerc[SUP] 1 [/SUP], Elise Yvin[SUP] 6 [/SUP], Nouchan Mellati[SUP] 5 [/SUP], Cyril Charron[SUP] 7 [/SUP], Guillaume Voiriot[SUP] 3 4 [/SUP], Yoann Picard[SUP] 5 [/SUP], Antoine Vieillard-Baron[SUP] 7 8 [/SUP], Michael Darmon[SUP] 6 [/SUP]
Affiliations
- PMID: 35853020
- DOI: 10.1371/journal.pone.0271358
Abstract
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.