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Title: | Differences and Similarities Among Coronavirus Disease 2019 Patients Treated in Seven ICUs in Three Countries Within One Region | Authors: | MESOTTEN, Dieter Meijs, Daniek A. M. van Bussel, Bas C. T. STESSEL, Bjorn Mehagnoul-Schipper, Jannet Hana, Anisa Scheeren, Clarissa I. E. Strauch, Ulrich van de Poll, Marcel C. G. Ghossein-Doha, Chahinda Buhre, Wolfgang F. F. A. Bickenbach, Johannes VANDER LAENEN, Margot Marx, Gernot van der Horst, Iwan C. C. |
Issue Date: | 2022 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | CRITICAL CARE MEDICINE, 50 (4) , p. 595 -606 | Abstract: | OBJECTIVES: To 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. DESIGN: Multicenter observational cohort study. SETTING: Seven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany. PATIENTS: Consecutive COVID-19 patients supported in the ICU during the first pandemic wave. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline 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. CONCLUSIONS: COVID-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. | Notes: | Meijs, DAM (corresponding author), Maastricht Univ, Dept Intens Care, Med Ctr, Maastricht, Netherlands.; Meijs, DAM (corresponding author), Laurentius Ziekenhuis, Dept Intens Care, Roermond, Netherlands. daniek.meijs@mumc.nl |
Keywords: | coronavirus disease 2019; critical care; delivery of healthcare;;healthcare economics and organizations; intensive care units; severe;acute respiratory syndrome coronavirus 2 | Document URI: | http://hdl.handle.net/1942/37206 | ISSN: | 0090-3493 | e-ISSN: | 1530-0293 | DOI: | 10.1097/CCM.0000000000005314 | ISI #: | WOS:000771070100027 | Rights: | 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. This is an open-access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Differences_and_Similarities_Among_COVID_19.7.pdf | Published version | 1.19 MB | Adobe PDF | View/Open |
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