• Timo Mayerhöfer, Sebastian J Klein, Andreas Peer, Fabian Perschinka, Georg F Lehner, Julia Hasslacher, Romuald Bellmann, Lukas Gasteiger, Markus Mittermayr, Stephan Eschertzhuber, Simon Mathis, Anna Fiala, Dietmar Fries, Armin Kalenka, Eva Foidl, Walter Hasibeder, Raimund Helbok, Lukas Kirchmair, Birgit Stögermüller, Christoph Krismer, Tatjana Heiner, Eugen Ladner, Claudius Thomé, Christian Preuß-Hernandez, Andreas Mayr, Agnes Pechlaner, Miriam Potocnik, Bruno Reitter, Jürgen Brunner, Stefanie Zagitzer-Hofer, Alexandra Ribitsch, and Michael Joannidis.
• Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
• Wien. Klin. Wochenschr. 2021 Dec 1; 133 (23-24): 1237-1247.

BackgroundWidely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients.MethodsThis multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic.ResultsOverall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54-74 years vs. 72 years, IQR 62-78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5-18 days vs. 18 days, IQR 5-31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort.ConclusionAdvanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.© 2021. The Author(s).

17 keywords...

hide…