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Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland.
Swiss Med Wkly. 2021 07 19; 151:w20553.SM

Abstract

AIMS OF THE STUDY

During the ongoing COVID-19 pandemic, the launch of a large-scale vaccination campaign and virus mutations have hinted at possible changes in transmissibility and the virulence affecting disease progression up to critical illness, and carry potential for future vaccination failure. To monitor disease development over time with respect to critically ill COVID-19 patients, we report near real-time prospective observational data from the RISC-19-ICU registry that indicate changed characteristics of critically ill patients admitted to Swiss intensive care units (ICUs) at the onset of a third pandemic wave.

METHODS

1829 of 3344 critically ill COVID-19 patients enrolled in the international RISC-19-ICU registry as of 31 May 2021 were treated in Switzerland and were included in the present study. Of these, 1690 patients were admitted to the ICU before 1 February 2021 and were compared with 139 patients admitted during the emerging third pandemic wave RESULTS: Third wave patients were a mean of 5.2 years (95% confidence interval [CI] 3.2&ndash;7.1) younger (median 66.0 years, interquartile range [IQR] 57.0&ndash;73.0 vs 62.0 years, IQR 54.5&ndash;68.0; p <0.0001) and had a higher body mass index than patients admitted in the previous pandemic period. They presented with lower SAPS II and APACHE II scores, less need for circulatory support and lower white blood cell counts at ICU admission. P/F ratio was similar, but a 14% increase in ventilatory ratio was observed over time (p = 0.03) CONCLUSION: Near real-time registry data show that the latest COVID-19 patients admitted to ICUs in Switzerland at the onset of the third wave were on average 5 years younger, had a higher body mass index, and presented with lower physiological risk scores but a trend towards more severe lung failure. These differences may primarily be related to the ongoing nationwide vaccination campaign, but the possibility that changes in virus-host interactions may be a co-factor in the age shift and change in disease characteristics is cause for concern, and should be taken into account in the public health and vaccination strategy during the ongoing pandemic. (ClinicalTrials.gov Identifier: NCT04357275).

Authors+Show Affiliations

Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.CTU Bern, University of Bern, Switzerland.Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.Swiss Society of Intensive Care Medicine, Basel, Switzerland.Department of Anaesthesiology and Critical Care Medicine, University Hospital of Nancy, France.Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, Netherlands.Health Geography and Policy Group, ETH Zürich, Switzerland.Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Switzerland.Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Switzerland.Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Switzerland.Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.No affiliation info available

Pub Type(s)

Journal Article
Comment

Language

eng

PubMed ID

34291810

Citation

Hilty, Matthias Peter, et al. "Near Real-time Observation Reveals Increased Prevalence of Young Patients in the ICU During the Emerging Third SARS-CoV-2 Wave in Switzerland." Swiss Medical Weekly, vol. 151, 2021, pp. w20553.
Hilty MP, Moser A, David S, et al. Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland. Swiss Med Wkly. 2021;151:w20553.
Hilty, M. P., Moser, A., David, S., Wendel Garcia, P. D., Capaldo, G., Keiser, S., Fumeaux, T., Guerci, P., Montomoli, J., Van Boeckel, T. P., Jeitziner, M. M., Que, Y. A., Jakob, S., Schüpbach, R. A., & Risc-Icu Investigators For Switzerland, . (2021). Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland. Swiss Medical Weekly, 151, w20553. https://doi.org/10.4414/smw.2021.20553
Hilty MP, et al. Near Real-time Observation Reveals Increased Prevalence of Young Patients in the ICU During the Emerging Third SARS-CoV-2 Wave in Switzerland. Swiss Med Wkly. 2021 07 19;151:w20553. PubMed PMID: 34291810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland. AU - Hilty,Matthias Peter, AU - Moser,André, AU - David,Sascha, AU - Wendel Garcia,Pedro David, AU - Capaldo,Giuliana, AU - Keiser,Stefanie, AU - Fumeaux,Thierry, AU - Guerci,Philippe, AU - Montomoli,Jonathan, AU - Van Boeckel,Thomas P, AU - Jeitziner,Marie-Madlen, AU - Que,Yok-Ai, AU - Jakob,Stefan, AU - Schüpbach,Reto Andreas, AU - Risc-Icu Investigators For Switzerland,, Y1 - 2021/07/21/ PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/7/27/medline SP - w20553 EP - w20553 JF - Swiss medical weekly JO - Swiss Med Wkly VL - 151 N2 - AIMS OF THE STUDY: During the ongoing COVID-19 pandemic, the launch of a large-scale vaccination campaign and virus mutations have hinted at possible changes in transmissibility and the virulence affecting disease progression up to critical illness, and carry potential for future vaccination failure. To monitor disease development over time with respect to critically ill COVID-19 patients, we report near real-time prospective observational data from the RISC-19-ICU registry that indicate changed characteristics of critically ill patients admitted to Swiss intensive care units (ICUs) at the onset of a third pandemic wave. METHODS: 1829 of 3344 critically ill COVID-19 patients enrolled in the international RISC-19-ICU registry as of 31 May 2021 were treated in Switzerland and were included in the present study. Of these, 1690 patients were admitted to the ICU before 1 February 2021 and were compared with 139 patients admitted during the emerging third pandemic wave RESULTS: Third wave patients were a mean of 5.2 years (95% confidence interval [CI] 3.2&ndash;7.1) younger (median 66.0 years, interquartile range [IQR] 57.0&ndash;73.0 vs 62.0 years, IQR 54.5&ndash;68.0; p <0.0001) and had a higher body mass index than patients admitted in the previous pandemic period. They presented with lower SAPS II and APACHE II scores, less need for circulatory support and lower white blood cell counts at ICU admission. P/F ratio was similar, but a 14% increase in ventilatory ratio was observed over time (p = 0.03) CONCLUSION: Near real-time registry data show that the latest COVID-19 patients admitted to ICUs in Switzerland at the onset of the third wave were on average 5 years younger, had a higher body mass index, and presented with lower physiological risk scores but a trend towards more severe lung failure. These differences may primarily be related to the ongoing nationwide vaccination campaign, but the possibility that changes in virus-host interactions may be a co-factor in the age shift and change in disease characteristics is cause for concern, and should be taken into account in the public health and vaccination strategy during the ongoing pandemic. (ClinicalTrials.gov Identifier: NCT04357275). SN - 1424-3997 UR - https://www.unboundmedicine.com/medline/citation/34291810/Near_real-time_observation_reveals_increased_prevalence_of_young_patients_in_the_ICU_during_the_emerging_third_SARS-CoV-2_wave_in_Switzerland. L2 - https://doi.emh.ch/10.4414/smw.2021.20553 DB - PRIME DP - Unbound Medicine ER -