Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland

Matthias Peter Hilty; André Moser; Sascha David; Pedro David Wendel Garcia; Giuliana Capaldo; Stefanie Keiser; Thierry Fumeaux; Philippe Guerci; Jonathan Montomoli; Thomas P Van Boeckel; Marie-Madlen Jeitziner; Yok-Ai Que; Stefan Jakob; Reto Andreas Schüpbach; RISC-19-ICU Investigators for Switzerland

doi:10.4414/smw.2021.20553

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 Jul 21:151:Swiss Med Wkly. 2021;151:w20553. doi: 10.4414/smw.2021.20553. eCollection 2021 Jul 19.

Authors

Matthias Peter Hilty¹, André Moser², Sascha David¹, Pedro David Wendel Garcia¹, Giuliana Capaldo¹, Stefanie Keiser¹, Thierry Fumeaux³, Philippe Guerci⁴, Jonathan Montomoli⁵, Thomas P Van Boeckel⁶, Marie-Madlen Jeitziner⁷, Yok-Ai Que⁷, Stefan Jakob⁷, Reto Andreas Schüpbach¹; RISC-19-ICU Investigators for Switzerland⁸

Affiliations

¹ Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.
² CTU Bern, University of Bern, Switzerland.
³ Swiss Society of Intensive Care Medicine, Basel, Switzerland.
⁴ Department of Anaesthesiology and Critical Care Medicine, University Hospital of Nancy, France.
⁵ Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, Netherlands.
⁶ Health Geography and Policy Group, ETH Zürich, Switzerland.
⁷ Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Switzerland.
⁸ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich (Reto A. Schüpbach MD; Philipp Bühler, MD; Silvio Brugger, MD, PhD; Jan Bartussek, PhD; Giuliana Capaldo, MD; Sascha David, MD; Stefanie Keiser, PhD; Martina Maibach, PhD; Annelies Zinkernagel, MD, PhD); Soins intensifs, Groupement Hospitalier de l'Ouest Lémanique - Hopital de Nyon, Nyon (Mallory Moret-Bochatay, MD); Interdisziplinaere Intensivstation, Spital Buelach, Buelach (Bernd Yuen, MD; Thomas Hillermann, MD); Soins Intensifs, Hopital cantonal de Fribourg, Fribourg (Hatem Ksouri, MD, PhD; Govind Oliver Sridharan, MD); Departement for intensive care medicine, Kantonsspital Nidwalden, Stans (Anette Ristic, MD; Michael Sepulcri, MD); Departement of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen (Miodrag Filipovic, MD; Urs Pietsch, MD); Intensivstation, Regionalspital Emmental AG, Burgdorf (Petra Salomon, MD; Iris Drvaric, MD); Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar (Peter Schott, MD; Severin Urech, MD); Intensivmedizin, St. Claraspital, Basel (Adriana Lambert, MD; Lukas Merki, MD); Department Intensive Care Medicine, Spitalzentrum Biel, Biel (Marcus Laube, MD); Intensivmedizin, Kantonsspital Graubünden, Chur (Frank Hillgaertner, MD; Marianne Sieber); Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld (Alexander Dullenkopf, MD; Lina Petersen, MD); Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals, Geneva (Serge Grazioli, MD; Peter C. Rimensberger, MD); Soins Intensifs, Hirslanden Clinique Cecil, Lausanne (Isabelle Fleisch, MD; Jerome Lavanchy, MD); Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne (Marie-Helene Perez, MD); Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf (Katharina Marquardt, MD; Karim Shaikh, MD); Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil (Hermann Redecker, MD); Intensivmedizin, Spital Oberengadin, Samedan (Michael Stephan, MD; Jan Brem, MD); Paediatric Intensive Care Unit, Children’s Hospital of Eastern Switzerland, St. Gallen (Bjarte Rogdo, MD; Andre Birkenmaier, MD); Klinik für Anaesthesie und Intensivmedizin, Spitalzentrum Oberwallis, Visp (Friederike Meyer zu Bentrup, MD, MBA); Interdisziplinaere Intensivstation, Stadtspital Triemli, Zurich (Patricia Fodor, MD; Pascal Locher, MD); Department Intensivmedizin, Universitaetsspital Basel, Basel (Martin Siegemund, MD; Nuria Zellweger); Department of Intensive Care Medicine, University Hospital Bern - Inselspital, Bern (Marie-Madlen Jeitziner, RN, PhD; Beatrice Jenni-Moser, RN, MSc); Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland (Jan Wiegand, MD); Intensivstation, Spital Grabs, Grabs (Christian Bürkle, MD); Medical ICU, Cantonal Hospital St.Gallen, St. Gallen (Gian-Reto Kleger, MD); Service d'Anesthesiologie, EHNV, Yverdon-les-Bains (Marilene Franchitti Laurent, MD; Jean-Christophe Laurent, MD); Abteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zürich (Tomislav Gaspert, MD; Marija Jovic, MD); Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten (Michael Studhalter, MD); Institut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich (Christoph Haberthuer, MD; Roger F. Lussman, MD); Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz (Daniela Selz, MD; Didier Naon, MD); Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano (Andrea Glotta, MD; Samuele Ceruti, MD); Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen (Julien Marrel, MD; Mirko Brenni, MD); Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau (Rolf Ensner, MD; Marc Michot, MD); Intensivstation, Kantonsspital Schaffhausen, Schaffhausen (Nadine Gehring, MD); Intensivstation, Spital Simmental-Thun-Saanenland AG, Thun (Antje Heise, MD); Klinik für Anaesthesie Intensivmedizin Operationszentrum und Schmerzmedizin, Kantonsspital Muensterlingen, Muensterlingen (Tobias Huebner, MD; Thomas A. Neff, MD); Division of Intensive Care, University Hospitals of Geneva, Geneva (Sara Cereghetti, MD; Filippo Boroli, MD; Jerome Pugin, MD, PhD).

PMID: 34291810
DOI: 10.4414/smw.2021.20553

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] 3.2–7.1) younger (median 66.0 years, interquartile range [IQR] 57.0–73.0 vs 62.0 years, IQR 54.5–68.0; 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).

MeSH terms

COVID-19*
Critical Illness
Hospital Mortality
Humans
Intensive Care Units
Pandemics
Prevalence
Prospective Studies
SARS-CoV-2*
Switzerland / epidemiology

Associated data

ClinicalTrials.gov/NCT04357275