Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry
Abstract 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 regist...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-07-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04065-2 |
| _version_ | 1818488571591393280 |
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| author | Pedro David Wendel-Garcia André Moser Marie-Madlen Jeitziner Hernán Aguirre-Bermeo Pedro Arias-Sanchez Janina Apolo Ferran Roche-Campo Diego Franch-Llasat Gian-Reto Kleger Claudia Schrag Urs Pietsch Miodrag Filipovic Sascha David Klaus Stahl Souad Bouaoud Amel Ouyahia Patricia Fodor Pascal Locher Martin Siegemund Nuria Zellweger Sara Cereghetti Peter Schott Gianfilippo Gangitano Maddalena Alessandra Wu Mario Alfaro-Farias Gerardo Vizmanos-Lamotte Hatem Ksouri Nadine Gehring Emanuele Rezoagli Fabrizio Turrini Herminia Lozano-Gómez Andrea Carsetti Raquel Rodríguez-García Bernd Yuen Anja Baltussen Weber Pedro Castro Jesus Oscar Escos-Orta Alexander Dullenkopf Maria C. Martín-Delgado Theodoros Aslanidis Marie-Helene Perez Frank Hillgaertner Samuele Ceruti Marilene Franchitti Laurent Julien Marrel Riccardo Colombo Marcus Laube Alberto Fogagnolo Michael Studhalter Tobias Wengenmayer Emiliano Gamberini Christian Buerkle Philipp K. Buehler Stefanie Keiser Muhammed Elhadi Jonathan Montomoli Philippe Guerci Thierry Fumeaux Reto A. Schuepbach Stephan M. Jakob Yok-Ai Que Matthias Peter Hilty the RISC-19-ICU Investigators |
| author_facet | Pedro David Wendel-Garcia André Moser Marie-Madlen Jeitziner Hernán Aguirre-Bermeo Pedro Arias-Sanchez Janina Apolo Ferran Roche-Campo Diego Franch-Llasat Gian-Reto Kleger Claudia Schrag Urs Pietsch Miodrag Filipovic Sascha David Klaus Stahl Souad Bouaoud Amel Ouyahia Patricia Fodor Pascal Locher Martin Siegemund Nuria Zellweger Sara Cereghetti Peter Schott Gianfilippo Gangitano Maddalena Alessandra Wu Mario Alfaro-Farias Gerardo Vizmanos-Lamotte Hatem Ksouri Nadine Gehring Emanuele Rezoagli Fabrizio Turrini Herminia Lozano-Gómez Andrea Carsetti Raquel Rodríguez-García Bernd Yuen Anja Baltussen Weber Pedro Castro Jesus Oscar Escos-Orta Alexander Dullenkopf Maria C. Martín-Delgado Theodoros Aslanidis Marie-Helene Perez Frank Hillgaertner Samuele Ceruti Marilene Franchitti Laurent Julien Marrel Riccardo Colombo Marcus Laube Alberto Fogagnolo Michael Studhalter Tobias Wengenmayer Emiliano Gamberini Christian Buerkle Philipp K. Buehler Stefanie Keiser Muhammed Elhadi Jonathan Montomoli Philippe Guerci Thierry Fumeaux Reto A. Schuepbach Stephan M. Jakob Yok-Ai Que Matthias Peter Hilty the RISC-19-ICU Investigators |
| author_sort | Pedro David Wendel-Garcia |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-10T16:52:56Z |
| format | Article |
| id | doaj.art-e59dbba5580e4dcbb1bbc0adac1d7610 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T16:52:56Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-e59dbba5580e4dcbb1bbc0adac1d76102022-12-22T01:40:50ZengBMCCritical Care1364-85352022-07-0126111410.1186/s13054-022-04065-2Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registryPedro David Wendel-Garcia0André Moser1Marie-Madlen Jeitziner2Hernán Aguirre-Bermeo3Pedro Arias-Sanchez4Janina Apolo5Ferran Roche-Campo6Diego Franch-Llasat7Gian-Reto Kleger8Claudia Schrag9Urs Pietsch10Miodrag Filipovic11Sascha David12Klaus Stahl13Souad Bouaoud14Amel Ouyahia15Patricia Fodor16Pascal Locher17Martin Siegemund18Nuria Zellweger19Sara Cereghetti20Peter Schott21Gianfilippo Gangitano22Maddalena Alessandra Wu23Mario Alfaro-Farias24Gerardo Vizmanos-Lamotte25Hatem Ksouri26Nadine Gehring27Emanuele Rezoagli28Fabrizio Turrini29Herminia Lozano-Gómez30Andrea Carsetti31Raquel Rodríguez-García32Bernd Yuen33Anja Baltussen Weber34Pedro Castro35Jesus Oscar Escos-Orta36Alexander Dullenkopf37Maria C. Martín-Delgado38Theodoros Aslanidis39Marie-Helene Perez40Frank Hillgaertner41Samuele Ceruti42Marilene Franchitti Laurent43Julien Marrel44Riccardo Colombo45Marcus Laube46Alberto Fogagnolo47Michael Studhalter48Tobias Wengenmayer49Emiliano Gamberini50Christian Buerkle51Philipp K. Buehler52Stefanie Keiser53Muhammed Elhadi54Jonathan Montomoli55Philippe Guerci56Thierry Fumeaux57Reto A. Schuepbach58Stephan M. Jakob59Yok-Ai Que60Matthias Peter Hilty61the RISC-19-ICU InvestigatorsInstitute of Intensive Care Medicine, University Hospital of ZurichClinical Trials Unit Bern, University of BernDepartment of Intensive Care Medicine, University Hospital BernUnidad de Cuidados Intensivos, Hospital Vicente Corral MoscosoUnidad de Cuidados Intensivos, Hospital Vicente Corral MoscosoUnidad de Cuidados Intensivos, Hospital Vicente Corral MoscosoIntensive Care Department, Hospital Verge de La Cinta de TortosaIntensive Care Department, Hospital Verge de La Cinta de TortosaMedizinische Intensivstation, Kantonsspital St. GallenMedizinische Intensivstation, Kantonsspital St. GallenDepartement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. GallenDepartement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. GallenInstitute of Intensive Care Medicine, University Hospital of ZurichMedical Intensive Care, Medical School HannoverDepartment of Internal Medicine, Centre Hospitalo Universitaire - Saadna Mohamed AbdnourDepartment of Internal Medicine, Centre Hospitalo Universitaire - Saadna Mohamed AbdnourInterdisziplinaere Intensivstation, Stadtspital Zurich - TriemliInterdisziplinaere Intensivstation, Stadtspital Zurich - TriemliDepartment Intensivmedizin, Universitaetsspital BaselDepartment Intensivmedizin, Universitaetsspital BaselDivision of Intensive Care, University Hospitals of GenevaInstitut Fuer Anesthaesie Und Intensivmedizin, Zuger Kantonsspital AGDepartment of Emergency Medicine, Ospedale InfermiDepartment of Internal Medicine, ASST Fatebenefratelli Sacco - “Luigi Sacco” HospitalUnidad de Cuidados Intensivos, Hospital Nostra Senyora de MeritxellUnidad de Cuidados Intensivos, Hospital Nostra Senyora de MeritxellSoins Intensifs, Hopital Cantonal de FribourgIntensivstation, Kantonsspital SchaffhausenDepartment of Anesthesia and Intensive Care Medicine, Policlinico San Marco - Gruppo Ospedaliero San DonatoInternal Medicine, Azienda Ospedaliera Universitaria di ModenaUnidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano BlesaAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti di AnconaServicio de Medicina Intensiva, Complejo Hospitalario Universitario A CoruñaInterdisziplinaere Intensivstation, Spital BuelachAnaesthesie Und Intensivmedizin, Kantonsspital BasellandMedical Intensive Care Unit, Hospital Clínic de Barcelona – IDIBAPS University of BarcelonaServicio de Medicina Intensiva, Hospital General San JorgeInstitut Fuer Anaesthesie und Intensivmedizin, Spital ThurgauServicio de Medicina Intensiva, Hospital Universitario de TorrejonIntensive Care Unit, St. Paul General HospitalPediatric Intensive Care Unit, University Hospital LausanneIntensivmedizin, Kantonsspital GraubuendenDipartimento Area Critica, Clinica Luganese MoncuccoService d’Anesthesiologie, EHNVInstitut Für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & KilchbergDivision of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - “Luigi Sacco” HospitalDepartment Intensive Care Medicine, Spitalzentrum BielAnesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di FerraraIntensivmedizin & Intermediate Care, Kantonsspital OltenDepartment of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of FreiburgDepartment of Anesthesia and Intensive Care, Infermi Hospital AUSL - RomagnaIntensivstation, Spital GrabsInstitute of Intensive Care Medicine, University Hospital of ZurichInstitute of Intensive Care Medicine, University Hospital of ZurichFaculty of Medicine, University of TripoliThe RISC-19-ICU Registry Board, University of ZurichThe RISC-19-ICU Registry Board, University of ZurichThe RISC-19-ICU Registry Board, University of ZurichInstitute of Intensive Care Medicine, University Hospital of ZurichDepartment of Intensive Care Medicine, University Hospital BernDepartment of Intensive Care Medicine, University Hospital BernInstitute of Intensive Care Medicine, University Hospital of ZurichAbstract 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.https://doi.org/10.1186/s13054-022-04065-2COVID-19PandemicIntensive care unitARDSDisease dynamics |
| spellingShingle | Pedro David Wendel-Garcia André Moser Marie-Madlen Jeitziner Hernán Aguirre-Bermeo Pedro Arias-Sanchez Janina Apolo Ferran Roche-Campo Diego Franch-Llasat Gian-Reto Kleger Claudia Schrag Urs Pietsch Miodrag Filipovic Sascha David Klaus Stahl Souad Bouaoud Amel Ouyahia Patricia Fodor Pascal Locher Martin Siegemund Nuria Zellweger Sara Cereghetti Peter Schott Gianfilippo Gangitano Maddalena Alessandra Wu Mario Alfaro-Farias Gerardo Vizmanos-Lamotte Hatem Ksouri Nadine Gehring Emanuele Rezoagli Fabrizio Turrini Herminia Lozano-Gómez Andrea Carsetti Raquel Rodríguez-García Bernd Yuen Anja Baltussen Weber Pedro Castro Jesus Oscar Escos-Orta Alexander Dullenkopf Maria C. Martín-Delgado Theodoros Aslanidis Marie-Helene Perez Frank Hillgaertner Samuele Ceruti Marilene Franchitti Laurent Julien Marrel Riccardo Colombo Marcus Laube Alberto Fogagnolo Michael Studhalter Tobias Wengenmayer Emiliano Gamberini Christian Buerkle Philipp K. Buehler Stefanie Keiser Muhammed Elhadi Jonathan Montomoli Philippe Guerci Thierry Fumeaux Reto A. Schuepbach Stephan M. Jakob Yok-Ai Que Matthias Peter Hilty the RISC-19-ICU Investigators Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry Critical Care COVID-19 Pandemic Intensive care unit ARDS Disease dynamics |
| title | Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry |
| title_full | Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry |
| title_fullStr | Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry |
| title_full_unstemmed | Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry |
| title_short | Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry |
| title_sort | dynamics of disease characteristics and clinical management of critically ill covid 19 patients over the time course of the pandemic an analysis of the prospective international multicentre risc 19 icu registry |
| topic | COVID-19 Pandemic Intensive care unit ARDS Disease dynamics |
| url | https://doi.org/10.1186/s13054-022-04065-2 |
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