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- Title
ICU strain and outcome in COVID-19 patients—A multicenter retrospective observational study.
- Authors
Demoule, Alexandre; Fartoukh, Muriel; Louis, Guillaume; Azoulay, Elie; Nemlaghi, Safaa; Jullien, Edouard; Desnos, Cyrielle; Clerc, Sebastien; Yvin, Elise; Mellati, Nouchan; Charron, Cyril; Voiriot, Guillaume; Picard, Yoann; Vieillard-Baron, Antoine; Darmon, Michael
- 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.
- Subjects
FRANCE; COVID-19; NASAL cannula; INTENSIVE care patients; HOSPITAL mortality; CHRONIC kidney failure
- Publication
PLoS ONE, 2022, Vol 17, Issue 7, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0271358