Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

Routsi, Christina; Magira, Eleni; Kokkoris, Stelios; Siembos, Ilias; Vrettou, Charikleia; Zervakis, Dimitrios; Ischaki, Eleni; Malahias, Sotiris; Sigala, Ioanna; Asimakos, Andreas; Daidou, Theodora; Kaltsas, Panagiotis; Douka, Evangelia; Sotiriou, Adamantia; Markaki, Vasiliki; Temberikidis, Prodromos; Koroneos, Apostolos; Politis, Panagiotis; Mastora, Zafiria; Dima, Efrosini; Tsoutsouras, Theodoros; Papahatzakis, Ioannis; Gioni, Panagiota; Strilakou, Athina; Maragouti, Aikaterini; Mizi, Eleftheria; Kanavou, Aggeliki; Sarri, Aikaterini; Gavrielatou, Evdokia; Mentzelopoulos, Spyros D.; Kalomenidis, Ioannis; Papastamopoulos, Vassilios; Kotanidou, Anastasia; Zakynthinos, Spyros

doi:10.3390/jcm9113730

Cited by 13 publications

(13 citation statements)

References 34 publications

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“…The rate of intubation and hospital mortality of intubated patients with coronavirus disease 2019 (COVID-19) in our ICUs at “Evangelismos” Hospital, Athens, Greece, during the first wave of the pandemic was reported to be 82% and 39%, respectively ( 1 ). Since then, changes in pharmacological treatments for severely ill patients with COVID-19 have been incorporated into clinical practice, both by their use (corticosteroids [ 2 ] and remdesivir [ 3 ]) and by stopping them (e.g., hydroxychloroquine).…”

mentioning

confidence: 99%

Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

Routsi

Kokkoris

Siempos

et al. 2021

Critical Care Explorations

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OBJECTIVES: Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubation and mortality of intubated patients in our ICUs between the first and second waves of the pandemic. DESIGN: Single-center, observational. SETTING: Four coronavirus disease 2019 designated ICUs at an urban Greek teaching hospital. PATIENTS: All adult patients with coronavirus disease 2019 consecutively admitted to ICU during the first ( n = 50) and second ( n = 212) waves of the pandemic. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The percentage of intubated ICU patients dropped from 82% during the first wave to 66% during the second wave ( p = 0.042). However, the absolute number of intubated ICU patients was lower during the first than the second wave (41 vs 140 patients). ICU or hospital mortality of intubated patients increased from 39% during the first wave to 60% during the second wave ( p = 0.028). The binary logistic regression for hospital mortality as the dependent variable in intubated patients and covariates the age, Acute Physiology and Chronic Health Evaluation II score, cardiovascular comorbidity, lactate, positive end-expiratory pressure, Sequential Organ Failure Assessment score, and wave, distinguished only Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.40 with 95% CI, 1.14—1.72; p = 0.001) as the sole independent predictor of hospital mortality. CONCLUSIONS: Pharmacological adaptations and other measures may have led to fewer intubations over time. However, these changes do not seem to be translated into improved outcomes of intubated patients. Perhaps the same change in the use of drugs and protocols that could cause fewer intubations of ICU patients might be a reason of increased mortality in those patients who are eventually intubated. Furthermore, the relative staff inexperience and overall increase in patients’ comorbidities during the second wave could have contributed to increased Acute Physiology and Chronic Health Evaluation II score and mortality of intubated patients.

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confidence: 99%

Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

Routsi

Kokkoris

Siempos

et al. 2021

Critical Care Explorations

Self Cite

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 63%

“…Other settings in our country have reported a lower mortality (32%) for overall ICU admissions during the first wave, highlighting the effects of an overburdened medical system on mortality rates rather than the severity of the disease per se (15). However, in a recently published Swedish registry-based cohort study of patients admitted from 6 March to 6 May 2020, the ICU mortality was even lower (23.1%) (16).…”

Section: Discussionmentioning

confidence: 78%

“…The reasons for this were the concern that early intubation of every hypoxemic patient would be impossible due to the limited ICU capacity and resources, and the possible beneficial effects of avoiding early endotracheal intubation in significantly hypoxemic patients (29). Also, this practice was based in part on evidence from other ICUs showing that a strategy of early intubation was not associated with higher ICU-mortality, fewer ventilator-free days, or fewer ICU-free days than delayed or no intubation (15,30,31). Until now, optimal timing of initiation of invasive mechanical ventilation in COVID-19 patients with acute hypoxemic respiratory failure remains unknown.…”

Section: Discussionmentioning

confidence: 99%

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Clinical course and outcomes of critically ill COVID-19 patients in two successive pandemic waves

Chalkias

Pantazopoulos

Papagiannakis³

et al. 2021

Preprint

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Rationale: The progress of COVID-19 from moderate to severe may be precipitous, while the heterogenous characteristics of the disease pose challenges to the management of these patients. Objectives: To characterize the clinical course and outcomes of critically ill patients with COVID-19 during two successive waves. Methods: We leveraged the multi-center SuPAR in Adult Patients With COVID-19 (SPARCOL) study and collected data from consecutive patients requiring admission to the intensive care unit from April 1st to November 30th, 2020. Measurements and Main Results: Of 252 patients, 81 (32%) required intubation and mechanical ventilation. Of them, 17 (20.9%) were intubated during the first wave, while 64 (79%) during the second wave. The most prominent difference between the two waves was the overall survival (first wave 58.9% vs. second wave 15.6%, adjusted p-value=0.006). This difference is reflected in the prolonged hospitalization during the first wave. The mean ICU length of stay (19.1 vs. 11.7 days, p=0.022), hospital length of stay (28.5 vs. 17.1 days, p=0.012), and days on ventilator (16.7 vs. 11.5, p=0.13) were higher during the first wave. A significant difference between the two waves was the development of bradycardia. In the first wave, 2 (11.7%) patients developed sinus bradycardia only after admission to the intensive care unit, while in the second wave, 63 (98.4%) patients developed sinus bradycardia during hospitalization. Conclusions: Survival of critically ill patients with COVID-19 was significantly lower during the second wave. The majority of these patients developed sinus bradycardia during hospitalization.

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“…Intensive care with sufficient hospital resources may reduce the mortality rate of severely ill patients. 3 However, invasive intervention in those patients with irregular immunity may lead to other complications, and death is inevitable in some patients. 4 Monitoring these cytokines provides clinicians with early signs of an overactive immune response and enables timely intervention.…”

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confidence: 99%

Reply to “Mortality-related immune features and COVID-19”

Cai

Zhou

Wang

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

Cited by 13 publications

References 34 publications

Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

Clinical course and outcomes of critically ill COVID-19 patients in two successive pandemic waves

Reply to “Mortality-related immune features and COVID-19”

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