Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark.
Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2023 Oct;67(9):1239-1248. doi: 10.1111/aas.14290. Epub 2023 Jun 8.
Among ICU patients with COVID-19, it is largely unknown how the overall outcome and resource use have changed with time, different genetic variants, and vaccination status.
For all Danish ICU patients with COVID-19 from March 10, 2020 to March 31, 2022, we manually retrieved data on demographics, comorbidities, vaccination status, use of life support, length of stay, and vital status from medical records. We compared patients based on the period of admittance and vaccination status and described changes in epidemiology related to the Omicron variant.
Among all 2167 ICU patients with COVID-19, 327 were admitted during the first (March 10-19, 2020), 1053 during the second (May 20, 2020 to June 30, 2021) and 787 during the third wave (July 1, 2021 to March 31, 2022). We observed changes over the three waves in age (median 72 vs. 68 vs. 65 years), use of invasive mechanical ventilation (81% vs. 58% vs. 51%), renal replacement therapy (26% vs. 13% vs. 12%), extracorporeal membrane oxygenation (7% vs. 3% vs. 2%), duration of invasive mechanical ventilation (median 13 vs. 13 vs. 9 days) and ICU length of stay (median 13 vs. 10 vs. 7 days). Despite these changes, 90-day mortality remained constant (36% vs. 35% vs. 33%). Vaccination rates among ICU patients were 42% as compared to 80% in society. Unvaccinated versus vaccinated patients were younger (median 57 vs. 73 years), had less comorbidity (50% vs. 78%), and had lower 90-day mortality (29% vs. 51%). Patient characteristics changed significantly after the Omicron variant became dominant including a decrease in the use of COVID-specific pharmacological agents from 95% to 69%.
In Danish ICUs, the use of life support declined, while mortality seemed unchanged throughout the three waves of COVID-19. Vaccination rates were lower among ICU patients than in society, but the selected group of vaccinated patients admitted to the ICU still had very severe disease courses. When the Omicron variant became dominant a lower fraction of SARS-CoV-2 positive patients received COVID treatment indicating other causes for ICU admission.
在 ICU 中患有 COVID-19 的患者中，总体预后和资源利用随时间变化、不同的遗传变异和接种状态而变化的情况尚不清楚。
对于 2020 年 3 月 10 日至 2022 年 3 月 31 日期间所有丹麦 ICU 中患有 COVID-19 的患者，我们从病历中手动检索了人口统计学、合并症、接种状态、生命支持使用、住院时间和生存状态的数据。我们根据入院时间和接种状态对患者进行了比较，并描述了与奥密克戎变异相关的流行病学变化。
在所有 2167 例 ICU 中患有 COVID-19 的患者中，327 例患者在第一波（2020 年 3 月 10 日至 19 日）、1053 例患者在第二波（2020 年 5 月 20 日至 6 月 30 日）和 787 例患者在第三波（2021 年 7 月 1 日至 2022 年 3 月 31 日）期间入院。我们观察到三波之间的年龄（中位数 72 岁、68 岁、65 岁）、有创机械通气使用率（81%、58%、51%）、肾脏替代疗法使用率（26%、13%、12%）、体外膜氧合使用率（7%、3%、2%）、有创机械通气持续时间（中位数 13 天、13 天、9 天）和 ICU 住院时间（中位数 13 天、10 天、7 天）的变化。尽管存在这些变化，但 90 天死亡率保持不变（36%、35%、33%）。与社会相比，ICU 患者的接种率为 42%。未接种疫苗的患者比接种疫苗的患者年轻（中位数 57 岁、73 岁）、合并症较少（50%、78%）、90 天死亡率较低（29%、51%）。奥密克戎变异株成为优势株后，患者特征发生了显著变化，包括 COVID 特异性药物的使用从 95%降至 69%。
在丹麦 ICU 中，生命支持的使用减少，而在 COVID-19 的三波疫情中，死亡率似乎没有变化。与社会相比，ICU 患者的接种率较低，但选择接种疫苗的 ICU 患者病情仍非常严重。当奥密克戎变异株成为优势株时，接受 SARS-CoV-2 治疗的阳性患者比例下降，这表明 ICU 入院的其他原因。
