• Dieter Mesotten, Daniek A M Meijs, Bas C T van Bussel, Björn Stessel, Jannet Mehagnoul-Schipper, Anisa Hana, Clarissa I E Scheeren, Ulrich Strauch, van de PollMarcel C GMCGDepartment of Intensive Care, Maastricht University Medical Center +, Maastricht, The Netherlands.Department of Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands.School for Nutrition and Translational Res, Chahinda Ghossein-Doha, BuhreWolfgang F F AWFFADivision for Acute and Emergency Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands., Johannes Bickenbach, Margot Vander Laenen, Gernot Marx, van der HorstIwan C CICCDepartment of Intensive Care, Maastricht University Medical Center +, Maastricht, The Netherlands.Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., and COVID Data Platform (CoDaP) Investigators.
• Department of Intensive Care, Ziekenhuis Oost-Limburg, Genk, Belgium.
• Crit. Care Med. 2022 Apr 1; 50 (4): 595606595-606.

ObjectivesTo investigate healthcare system-driven variation in general characteristics, interventions, and outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU within one Western European region across three countries.DesignMulticenter observational cohort study.SettingSeven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany.PatientsConsecutive COVID-19 patients supported in the ICU during the first pandemic wave.InterventionsNone.Measurements And Main ResultsBaseline demographic and clinical characteristics, laboratory values, and outcome data were retrieved after ethical approval and data-sharing agreements. Descriptive statistics were performed to investigate country-related practice variation. From March 2, 2020, to August 12, 2020, 551 patients were admitted. Mean age was 65.4 ± 11.2 years, and 29% were female. At admission, Acute Physiology and Chronic Health Evaluation II scores were 15.0 ± 5.5, 16.8 ± 5.5, and 15.8 ± 5.3 (p = 0.002), and Sequential Organ Failure Assessment scores were 4.4 ± 2.7, 7.4 ± 2.2, and 7.7 ± 3.2 (p < 0.001) in the Belgian, Dutch, and German parts of Euregio, respectively. The ICU mortality rate was 22%, 42%, and 44%, respectively (p < 0.001). Large differences were observed in the frequency of organ support, antimicrobial/inflammatory therapy application, and ICU capacity. Mixed-multivariable logistic regression analyses showed that differences in ICU mortality were independent of age, sex, disease severity, comorbidities, support strategies, therapies, and complications.ConclusionsCOVID-19 patients admitted to ICUs within one region, the Euregio Meuse-Rhine, differed significantly in general characteristics, applied interventions, and outcomes despite presumed genetic and socioeconomic background, admission diagnosis, access to international literature, and data collection are similar. Variances in healthcare systems' organization, particularly ICU capacity and admission criteria, combined with a rapidly spreading pandemic might be important drivers for the observed differences. Heterogeneity between patient groups but also healthcare systems should be presumed to interfere with outcomes in coronavirus disease 2019.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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