Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

Alexis Ferré; Myriam Lamamri; Marc Delord; Georges Abi-Abdallah; Antoine Gros; Guillaume Lacave; Virginie Laurent; Fabien Marquion; Sybille Merceron; Marine Paul; Gilles Troché; Raphaele Convers-Domart; Stéphanie Marque-Juillet; Stéphane Legriel; Fabrice Bruneel

doi:10.1159/000530297

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

Alexis Ferré^*, Myriam Lamamri, Marc Delord, Georges Abi-Abdallah, Antoine Gros, Guillaume Lacave, Virginie Laurent, Fabien Marquion, Sybille Merceron, Marine Paul, Gilles Troché, Raphaele Convers-Domart, Stéphanie Marque-Juillet, Stéphane Legriel, Fabrice Bruneel

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54-72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.

Original language	English
Pages (from-to)	426-438
Number of pages	13
Journal	Respiration
Volume	102
Issue number	6
DOIs	https://doi.org/10.1159/000530297
Publication status	Published - 1 Jun 2023

Keywords

Acute respiratory failure
COVID-19
Intensive care unit
Mortality
Second/third waves

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10.1159/000530297

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Ferré, A., Lamamri, M., Delord, M., Abi-Abdallah, G., Gros, A., Lacave, G., Laurent, V., Marquion, F., Merceron, S., Paul, M., Troché, G., Convers-Domart, R., Marque-Juillet, S., Legriel, S., & Bruneel, F. (2023). Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort. Respiration, 102(6), 426-438. https://doi.org/10.1159/000530297

@article{fd63f0d9db58461ca6d2c100fe54352d,

title = "Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort",

abstract = "Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54-72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.",

keywords = "Acute respiratory failure, COVID-19, Intensive care unit, Mortality, Second/third waves",

author = "Alexis Ferr{\'e} and Myriam Lamamri and Marc Delord and Georges Abi-Abdallah and Antoine Gros and Guillaume Lacave and Virginie Laurent and Fabien Marquion and Sybille Merceron and Marine Paul and Gilles Troch{\'e} and Raphaele Convers-Domart and St{\'e}phanie Marque-Juillet and St{\'e}phane Legriel and Fabrice Bruneel",

note = "Funding Information: The study was supported by the French public funding agency D{\'e}l{\'e}gation {\`a} la Recherche Clinique et {\`a} l{\textquoteright}Innovation (DRCI), Le Chesnay, France. No funding was received for this study. Publisher Copyright: {\textcopyright} 2023 S. Karger AG, Basel. All rights reserved.",

year = "2023",

month = jun,

day = "1",

doi = "10.1159/000530297",

language = "English",

volume = "102",

pages = "426--438",

journal = "Respiration",

issn = "0025-7931",

publisher = "Karger Publishers",

number = "6",

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Ferré, A, Lamamri, M, Delord, M, Abi-Abdallah, G, Gros, A, Lacave, G, Laurent, V, Marquion, F, Merceron, S, Paul, M, Troché, G, Convers-Domart, R, Marque-Juillet, S, Legriel, S & Bruneel, F 2023, 'Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort', Respiration, vol. 102, no. 6, pp. 426-438. https://doi.org/10.1159/000530297

TY - JOUR

T1 - Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves

T2 - A Prospective Observational Cohort

AU - Ferré, Alexis

AU - Lamamri, Myriam

AU - Delord, Marc

AU - Abi-Abdallah, Georges

AU - Gros, Antoine

AU - Lacave, Guillaume

AU - Laurent, Virginie

AU - Marquion, Fabien

AU - Merceron, Sybille

AU - Paul, Marine

AU - Troché, Gilles

AU - Convers-Domart, Raphaele

AU - Marque-Juillet, Stéphanie

AU - Legriel, Stéphane

AU - Bruneel, Fabrice

N1 - Funding Information: The study was supported by the French public funding agency Délégation à la Recherche Clinique et à l’Innovation (DRCI), Le Chesnay, France. No funding was received for this study. Publisher Copyright: © 2023 S. Karger AG, Basel. All rights reserved.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54-72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.

AB - Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54-72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.

KW - Acute respiratory failure

KW - COVID-19

KW - Intensive care unit

KW - Mortality

KW - Second/third waves

UR - http://www.scopus.com/inward/record.url?scp=85163613612&partnerID=8YFLogxK

U2 - 10.1159/000530297

DO - 10.1159/000530297

M3 - Article

C2 - 37231952

AN - SCOPUS:85163613612

SN - 0025-7931

VL - 102

SP - 426

EP - 438

JO - Respiration

JF - Respiration

IS - 6

ER -

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

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