Naouri Diane, Vuagnat Albert, Beduneau Gaëtan, Dres Martin, Pham Tai, Mercat Alain, Combes Alain, Demoule Alexandre, Kimmoun Antoine, Schmidt Matthieu, Jamme Matthieu
Department for Research, Studies, Assessment and Statistics (DREES), French Ministry of Health, 10 Place Des 5 Martyrs du Lycée Buffon, 75014, Paris, France.
UNIROUEN, EA 3830, Medical Intensive Care Unit, Rouen University Hospital, Normandie University, 76000, Rouen, France.
Ann Intensive Care. 2023 Jan 12;13(1):2. doi: 10.1186/s13613-022-01097-3.
Studies regarding coronavirus disease 2019 (COVID-19) were mainly performed in the initial wave, but some small-scale data points to prognostic differences for patients in successive waves. We therefore aimed to study the impact of time on prognosis of ICU-admitted COVID-19 patients.
We performed a national retrospective cohort study, including all adult patients hospitalized in French ICUs from March 1, 2020 to June 30, 2021, and identified three surge periods. Primary and secondary outcomes were in-hospital mortality and need for invasive mechanical ventilation, respectively.
105,979 critically ill ICU-admitted COVID-19 patients were allocated to the relevant three surge periods. In-hospital mortality for surges 1, 2, and 3 was, respectively, 24%, 27%, and 24%. Invasive mechanical ventilation was the highest level of respiratory support for 42%, 32%, and 31% (p < 0.001) over the whole period, with a decline in the use of vasopressors over time. Adjusted for age, sex, comorbidities, and modified Simplified Acute Physiology Score II at ICU admission, time period was associated with less invasive mechanical ventilation and a high risk of in-hospital death. Vaccination against COVID-19 was associated with a lower likelihood of invasive mechanical ventilation (adjusted sub-hazard ratio [aSHR] = 0.64 [0.53-0.76]) and intra-hospital death (aSHR = 0.80, [0.68-0.95]).
In this large database of ICU patients admitted for COVID-19, we observed a decline in invasive mechanical ventilation, vasopressors, and RRT use over time but a high risk of in-hospital death. Vaccination was identified as protective against the risk of invasive mechanical ventilation and in-hospital death.
关于2019冠状病毒病（COVID-19）的研究主要在第一波疫情期间进行，但一些小规模数据表明，后续几波疫情中的患者预后存在差异。因此，我们旨在研究时间对入住重症监护病房（ICU）的COVID-19患者预后的影响。
我们进行了一项全国性回顾性队列研究，纳入了2020年3月1日至2021年6月30日期间在法国ICU住院的所有成年患者，并确定了三个高峰时期。主要和次要结局分别是住院死亡率和有创机械通气需求。
105979例入住ICU的COVID-19重症患者被分配到相关的三个高峰时期。第一波、第二波和第三波疫情期间的住院死亡率分别为24%、27%和24%。在整个期间，有创机械通气是42%、32%和31%患者最高级别的呼吸支持（p<0.001），血管活性药物的使用随时间减少。在对年龄、性别、合并症以及入住ICU时的改良简化急性生理学评分II进行调整后，时间段与有创机械通气减少和住院死亡高风险相关。接种COVID-19疫苗与有创机械通气可能性较低（调整后亚风险比[aSHR]=0.64[0.53-0.76]）和院内死亡可能性较低（aSHR=0.80，[0.68-0.95]）相关。
在这个因COVID-19入住ICU患者的大型数据库中，我们观察到随着时间推移，有创机械通气、血管活性药物和肾脏替代治疗的使用减少，但住院死亡风险较高。疫苗接种被确定为可预防有创机械通气风险和住院死亡。
