key: cord-1028299-7ddivl1v authors: Guillon, Antoine; Laurent, Emeline; Godillon, Lucile; Kimmoun, Antoine; Grammatico-Guillon, Leslie title: In-hospital mortality rates of critically ill COVID-19 patients in France: a nationwide cross-sectional study of 45,409 ICU patients date: 2021-08-14 journal: Br J Anaesth DOI: 10.1016/j.bja.2021.08.006 sha: 185e87c177b3d4cf280a539953b91e3cd196d0a1 doc_id: 1028299 cord_uid: 7ddivl1v nan Particular trends can be highlighted. A reduction of mortality rate appeared to be observed in the first weeks of the pandemic surge (weeks 10-13, 2020). Meanwhile, a decreasing use of invasive ventilation support was observed the same weeks. Weeks 19-30 (2020) should be interpreted with caution considering the low incidence of COVID-19 over the summer period. Changes were observed in the patient phenotype at that time: increased morbidities at presentation, lowest sex ratio, and peaks in mortality. Over the 12-month study period, age, SAPS II, and the use of invasive ventilation support were remarkably constant (except for weeks 10-13). This study also has limitations. First, the use of administrative hospital databases introduced an inherent bias that must be considered. The strengths and limitations of using healthcare databases for epidemiological purposes have been extensively discussed. [5] [6] [7] Briefly, the lack of granularity of the database could be a limiting factor, but conversely, it is an exhaustive real-life record of all patients hospitalized without initial selection bias. Second, patients were included up to 14 March 2021 and data were extracted on 11 June 2021. Consequently, missing discharge summary data are possible for patients with extremely long ICU length of stay occurring at the end of the study period, which could have biased the results of the last weeks. Last, these results are difficult to interpret without the number of cases in the general population. However, one has to keep in mind that detection of cases of COVID-19 was suboptimal at the beginning of the pandemic in the general population in France. 8 The incidence rate in the general population would have represented an inconsistent indicator for the present study. We preferred to refer to ICU admissions for COVID-19 as a surrogate for the burden on the healthcare system. We provide a national surveillance of all ICU patients with COVID-19 hospitalized during the first year of the pandemic in France. Despite an extraordinary year for science and a constant flow of new therapeutic strategies proposed during the study period, ICU outcome of COVID-19 patients was not improved. AG, LGG, LG, EL conceived and designed the study and were involved in drafting the manuscript. LG performed the data retrieval LG, EL, AG and LGG performed the statistical analysis. All authors were involved in the interpretation of the data, in drafting the manuscript and made critical revisions to the discussion section, and read and approved the final version to be published. Inter-regional transfers for pandemic surges were associated with reduced mortality rates Long-term mortality of elderly patients after intensive care unit admission for COVID-19 Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries Practical considerations on the use of the Charlson comorbidity index with administrative data bases Long-term outcome of severe herpes simplex encephalitis: a population-based observational study Clinical and economic outcomes of infective endocarditis Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity score-matched cohort study Underdetection of cases of COVID-19 in France threatens epidemic control Deaths were assigned to the week of admission. Clinical characteristics (six figures of the lower panel) are represented as median (with first and third interquartile ranges as dashed lines) or rate with a distribution of patients according to the Charlson comorbidity index (Charlson CI) in three categories. ICU LOS, ICU length of stay We thank all staffs of health care facilities who contributed to the Hospital Discharge Database implementation.Restrictions apply to the availability of these data and so they are not publicly available. However, data are available from the authors upon reasonable request and with the permission of the institution. The authors declare that they have no conflict of interest.