Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.
INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
PLoS One. 2022 Jul 19;17(7):e0271358. doi: 10.1371/journal.pone.0271358. eCollection 2022.
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.
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.
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.
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.
比较 COVID-19 大流行前两波期间入住重症监护病房（ICU）的患者的特征、治疗方法和预后，并评估 ICU 压力（因 COVID-19 入院导致的 ICU 需求）与死亡率之间的关系。
在一项多中心回顾性研究中，纳入了 2020 年 2 月 20 日至 12 月 31 日期间法国五家 ICU 收治的 1166 例 COVID-19 患者。数据由各 ICU 从病历中收集。Cox 比例风险模型确定了与 28 天死亡率相关的因素。
640 例患者（55%）于第一波（2020 年 2 月至 6 月）入院，526 例（45%）于第二波（2020 年 7 月至 12 月）入院。第二波 ICU 压力较低（与研究期间各中心平均 COVID-19 入院人数相比，分别为-0.81 [-1.04 --0.31]和 1.18 [-0.34-1.29]SD，P<0.001）。第二波入院患者年龄较大，存在更严重的低氧血症和较低的 SOFA 评分。第二波期间更常使用高流量鼻导管（68%比 39%，P<0.001），气管插管较少（46%比 69%，P<0.001）。第一波和第二波的 28 天死亡率（分别为 30%和 26%，P=0.12）和住院死亡率（分别为 37%和 31%，P=0.27）无差异。超重和肥胖与较低的 28 天死亡率相关，而年龄较大、患有慢性肾脏疾病、SOFA 评分评估的 ICU 入院严重程度和 ICU 压力与较高的 28 天死亡率相关。ICU 压力与住院死亡率无关。
大流行的第一波和第二波期间患者的特征和治疗方法有所不同。与波次相比，ICU 压力与 28 天死亡率独立相关，但与住院死亡率无关。
