Termorshuizen Fabian, Dongelmans Dave A, Brinkman Sylvia, Bakhshi-Raiez Ferishta, Arbous M Sesmu, de Lange Dylan W, van Bussel Bas C T, de Keizer Nicolette F
National Intensive Care Evaluation (NICE) Foundation, Postbus 23640, 1100, EC, Amsterdam, The Netherlands.
Amsterdam UMC, Department of Medical Informatics, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
Ann Intensive Care. 2024 Jan 16;14(1):11. doi: 10.1186/s13613-023-01238-2.
Previously, we reported a decreased mortality rate among patients with COVID-19 who were admitted at the ICU during the final upsurge of the second wave (February-June 2021) in the Netherlands. We examined whether this decrease persisted during the third wave and the phases with decreasing incidence of COVID-19 thereafter and brought up to date the information on patient characteristics.
Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and rates of in-hospital mortality (the primary outcome) during the consecutive periods after the first wave (periods 2-9, May 25, 2020-January 31, 2023) were compared with those during the first wave (period 1, February-May 24, 2020).
After adjustment for patient characteristics and ICU occupancy rate, the mortality risk during the initial upsurge of the third wave (period 6, October 5, 2021-January, 31, 2022) was similar to that of the first wave (OR = 1.01, 95%-CI [0.88-1.16]). The mortality rates thereafter decreased again (e.g., period 9, October 5, 2022-January, 31, 2023: OR = 0.52, 95%-CI [0.41-0.66]). Among the SARS-CoV-2 positive patients, there was a huge drop in the proportion of patients with COVID-19 as main reason for ICU admission: from 88.2% during the initial upsurge of the third wave to 51.7%, 37.3%, and 41.9% for the periods thereafter. Restricting the analysis to these patients did not modify the results on mortality.
The results show variation in mortality rates among critically ill COVID-19 patients across the calendar time periods that is not explained by differences in case-mix and ICU occupancy rates or by varying proportions of patients with COVID-19 as main reason for ICU admission. The consistent increase in mortality during the initial, rising phase of each separate wave might be caused by the increased virulence of the contemporary virus strain and lacking immunity to the new strain, besides unmeasured patient-, treatment- and healthcare system characteristics.
此前，我们报告了在荷兰第二波疫情（2021年2月至6月）最后一次激增期间入住重症监护病房（ICU）的新冠病毒病（COVID-19）患者死亡率有所下降。我们研究了这种下降在第三波疫情期间以及此后COVID-19发病率下降阶段是否持续，并更新了患者特征信息。
使用荷兰全国重症监护评估（NICE）登记处的所有COVID-19患者入住ICU的数据。将第一波疫情后连续各时期（第2 - 9期，2020年5月25日至2023年1月31日）的患者特征和院内死亡率（主要结局）与第一波疫情期间（第1期，2020年2月至5月24日）进行比较。
在对患者特征和ICU占用率进行调整后，第三波疫情初期激增阶段（第6期，2021年10月5日至2022年1月31日）的死亡风险与第一波疫情相似（比值比[OR]=1.01，95%置信区间[CI][0.88 - 1.16]）。此后死亡率再次下降（例如，第9期，2022年10月5日至2023年1月31日：OR = 0.52，95%CI[0.41 - 0.66]）。在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）阳性患者中，以COVID-19作为入住ICU主要原因的患者比例大幅下降：从第三波疫情初期激增阶段的88.2%降至此后各时期的51.7%、37.3%和41.9%。将分析限制在这些患者中并未改变死亡率结果。
结果显示，重症COVID-19患者的死亡率在不同日历时间段存在差异，这种差异无法用病例组合和ICU占用率的差异或因COVID-19作为入住ICU主要原因的患者比例变化来解释。除了未测量的患者、治疗和医疗系统特征外，每一波疫情初期上升阶段死亡率的持续增加可能是由当时病毒株毒力增强以及对新毒株缺乏免疫力所致。
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