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Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: A national database study

2023; Elsevier BV; Volume: 87; Issue: 2 Linguagem: Inglês

10.1016/j.jinf.2023.05.011

1532-2742

Diane Naouri, Tài Pham, Martin Dres, Albert Vuagnat, G. Béduneau, Alain Mercat, Alain Combes, Antoine Kimmoun, Matthieu Schmidt, Alexandre Demoule, Matthieu Jamme,

Sepsis Diagnosis and Treatment

ObjectivePrior to the coronavirus disease 2019 (COVID-19) pandemic, influenza was the most frequent cause of viral respiratory pneumonia requiring intensive care unit (ICU) admission. Few studies have compared the characteristics and outcomes of critically ill patients with COVID-19 and influenza.MethodsThis was a French nationwide study comparing COVID-19 (March 1, 2020–June 30, 2021) and influenza patients (January 1, 2014–December 31, 2019) admitted to an ICU during pre-vaccination era. Primary outcome was in-hospital death. Secondary outcome was need for mechanical ventilation.Results105,979 COVID-19 patients were compared to 18,763 influenza patients. Critically ill patients with COVID-19 were more likely to be men with more comorbidities. Patients with influenza required more invasive mechanical ventilation (47 vs. 34%, p < 0·001), vasopressors (40% vs. 27, p < 0·001) and renal-replacement therapy (22 vs. 7%, p < 0·001). Hospital mortality was 25% and 21% (p < 0·001) in patients with COVID-19 and influenza, respectively. In the subgroup of patients receiving invasive mechanical ventilation, ICU length of stay was significantly longer in patients with COVID-19 (18 [10–32] vs. 15 [8–26] days, p < 0·001). Adjusting for age, gender, comorbidities, and modified SAPS II score, in-hospital death was higher in COVID-19 patients (adjusted sub-distribution hazard ratio [aSHR]=1.69; 95%CI=1.63–1.75) compared with influenza patients. COVID-19 was also associated with less invasive mechanical ventilation (aSHR=0.87; 95%CI=0.85–0.89) and a higher likelihood of death without invasive mechanical ventilation (aSHR=2.40; 95%CI=2.24–2.57).ConclusionDespite younger age and lower SAPS II score, critically ill COVID-19 patients had a longer hospital stay and higher mortality than patients with influenza.