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. 2024 Dec 20:36:e202400251en.
doi: 10.62675/2965-2774.20240251-en. eCollection 2024.

Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry

[Article in English, Portuguese]
Safira A Wortel  1   2 , Ferishta Bakhshi-Raiez  1   2 , Ameen Abu-Hanna  1 , Dave A Dongelmans  2   3 , Nicolette F de Keizer  1   2 ; Dutch COVID-19 Research Consortium  4 ; Aletta Houwink  4 , Allard Dijkhuizen  5 , Annelies Draisma  6 , Annemiek Rijkeboer  7 , Arjan Cloïn  8 , Arthur de Meijer  9 , Auke Reidinga  10 , Barbara Festen-Spanjer  11 , Bas van Bussel  12 , Bob Eikemans  13 , Cretièn Jacobs  14 , David Moolenaar  10 , Dharmanand Ramnarain  15 , Dick Koning  16 , Dirk Boer  17 , Dirk Verbiest  18 , Eline van Slobbe-Bijlsma  19 , Ellen van Koppen  20 , Els Rengers  21 , Erik van Driel  22 , Eva Verweij  23 , Freya van Iersel  24 , Gert Brunnekreef  25 , Hans Kieft  26 , Herman Kreeftenberg  27 , Ilanit Hené  28 , Inge Janssen  29 , Ionana Drogt  30 , Iwan van der Horst  12 , Jan Jaap Spijkstra  31 , Jan Rozendaal  32 , Jannet Mehagnoul-Schipper  33 , Jelle Epker Erasmus  34 , Jessica Holtkamp  35 , Johan Lutisan  36 , Jos van Oers  37 , Judith Lens  38 , Laura van Gulik  39 , Lettie van den Berg  40 , Louise Urlings-Strop  41 , Lyuba Georgieva  42 , Maarten van Lieshout  43 , Marga Hoogendoorn  26 , Marissa Vrolijk-de Mos  44 , Mart de Graaff  45 , Martha de Bruin  46 , Martijn Hoeksema  47 , Martijn van Tellingen  48 , Michel Barnas  49 , Michiel Erkamp  50 , Niels Gritters  51 , Nuray Kusadasi  52 , Paul Elbers  31 , Peter Koetsier  53 , Peter Spronk  54 , Peter van der Voort  55 , Ralph Pruijsten  56 , Remko de Jong  57 , Robert-Jan Bosman  58 , Ronald Wesselink  45 , Ronny Schnabel  12 , Roy van den Berg  15 , Ruud de Waal  59 , Sesmu Arbous  60 , Silvia Knape  61 , Stefaan Hendriks  62 , Tim Frenzel  63 , Tom Dormans  64 , Tom Rijpstra  59 , Vera Silderhuis  65 , Wouter de Ruijter  66
Affiliations

Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry

[Article in English, Portuguese]
Safira A Wortel et al. Crit Care Sci. .

Abstract
in English, Portuguese

Objective: To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.

Methods: We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.

Results: We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.

Conclusion: For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.

Objetivo:: Descrever a mortalidade em 12 meses de pacientes holandeses com COVID-19 internados em unidades de terapia intensiva, a população total com COVID-19 e vários subgrupos segundo o número de comorbidades, idade, sexo, ventilação mecânica e uso de medicação vasoativa.

Métodos:: Incluímos todos os pacientes admitidos com COVID-19 entre 1° de março de 2020 e 29 de março de 2022, do banco de dados do registro holandês National Intensive Care Evaluation (NICE). A taxa bruta de mortalidade em 12 meses é apresentada por meio das curvas de sobrevida de Kaplan-Meier para cada subgrupo de pacientes. Usamos modelos de regressão de Cox para analisar os efeitos das características do paciente na mortalidade em 12 meses após a alta hospitalar.

Resultados:: Incluímos 16.605 pacientes com COVID-19. A taxa de mortalidade hospitalar foi de 28,1%, e a taxa de mortalidade em 12 meses após a admissão na unidade de terapia intensiva foi de 29,8%. Entre os sobreviventes hospitalares, a mortalidade em 12 meses após a alta hospitalar foi de 2,5% (300/11.931). O risco de morte em 12 meses após a alta hospitalar foi maior em pacientes entre 60 e 79 anos (HR 4,74; IC95% 2,23 - 10,06) e ≥ 80 anos (HR 22,77; IC95% 9,91 - 52,28) do que em pacientes < 40 anos de idade; em pacientes do sexo masculino do que do sexo feminino (HR de 1,38; IC95% 1,07 - 1,78); e em pacientes com uma comorbidade (HR ajustado 1,95; IC95% 1,5 - 2,53), duas comorbidades (HR ajustado 4,49; IC95% 3,27 - 6,16) ou mais de duas (HR ajustado 4,99; IC95% 2,62 - 9,5) do que em pacientes sem comorbidades. Nem o uso de medicação vasoativa nem a ventilação mecânica apresentaram resultados estatisticamente significativos.

Conclusão:: A maioria das mortes de pacientes holandeses com COVID-19 na unidade de terapia intensiva ocorreu durante a internação hospitalar. Para os sobreviventes do hospital, a taxa bruta de mortalidade em 12 meses foi baixa. A idade do paciente (acima de 60 anos), o sexo e o número de comorbidades foram associados a um maior risco de morte 12 meses após a alta hospitalar, enquanto a ventilação mecânica e a medicação vasoativa não foram.

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Conflict of interest statement

Conflicts of interest: N. F. Keizer and D.A. Dongelmans are members of the board of the Dutch National Intensive Care Evaluation (NICE) foundation. The NICE foundation pays the department of Medical Informatics, Amsterdam UMC, for processing data of all Dutch ICUs into audit and feedback information. S. A. Wortel, N. F. Keizer, and F. Bakhshi-Raiez are employees of the department of medical informatics and work on the NICE project.

Figures

Figure 1
Figure 1. Kaplan-Meier survival curves of COVID-19 patients after intensive care unit admission.
Figure 2
Figure 2. Kaplan-Meier survival curves of COVID-19 patients after hospital discharge compared with those of the general Dutch population. The solid line represents the COVID-19 intensive care unit study population, and the dashed line represents the general Dutch population.
Figura 1
Figura 1. Curvas de sobrevivência Kaplan-Meier de pacientes com COVID-19 após a admissão na unidade de terapia intensiva.
Figura 2
Figura 2. Curvas de sobrevida de Kaplan-Meier de pacientes com COVID-19 após a alta hospitalar em comparação com as da população holandesa em geral. A linha contínua representa a população do estudo na unidade de terapia intensiva com COVID-19, e a linha tracejada representa a população holandesa em geral.
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