Available online 10 October 2023, 105600

Author links open overlay panel, , , , , , , , ABSTRACTRationale

Several authors have compared COVID-19 infection with influenza in the ICU.

Objective

This study aimed to compare the baseline clinical profiles, care procedures, and mortality outcomes of patients admitted to the intensive care unit, categorized by infection status (Influenza vs. COVID-19).

Methods

Retrospective observational study. Data were extracted from the Toulouse University Hospital from March 2014 to March 2021. To compare survival curves, we plotted the survival at Day-90 using the Kaplan-Meier curve and conducted a log-rank test. Additionally, we performed propensity score matching to adjust for confounding factors between the COVID-19 and influenza groups. Furthermore, we use the CART model for multivariate analysis.

Results

The study included 363 patients admitted to the ICU due to severe viral pneumonia: 152 patients (41.9%) with influenza and 211 patients (58.1%) with COVID-19. COVID-19 patients exhibited a higher prevalence of cardiovascular risk factors, whereas influenza patients had significantly higher severity scores (SOFA: 10 [6-12] vs. 6 [3-9], p<0.01 and SAPS II: 51 [35-67] vs. 37 [29-50], p<0.001). Overall mortality rates were comparable between the two groups (27.6% (n=42) in the influenza group vs. 21.8% (n=46) in the COVID-19 group, p=NS). Mechanical ventilation was more commonly employed in the influenza group (76.3% (n=116) vs. 59.7% (n=126), p<0.001); however, COVID-19 patients required longer durations of mechanical ventilation (18 [9-29] days vs. 13 [5-24] days, p<0.006) and longer hospital stays (23 [13-34] days vs. 18.5 [9-34.5] days, p=0.009). The CART analysis revealed that the use of extra renal replacement therapy was the most influential prognostic factor in the influenza group, while the PaO2/FiO2-PEEP ratio played a significant role in the COVID-19 group.

Conclusions

Despite differences in clinical presentation and prognostic factors, the mortality rates at 90 days, after adjusting for confounding factors, were similar between COVID-19 and influenza patients.

Section snippetsINTRODUCTION

On December 2019, a novel pneumonia was detected in Wuhan in China which quickly spread around the world, resulting in a pandemic. The World Health Organization (WHO) officially named this novel coronavirus disease 2019 (COVID-19) whereas the International Committee on Taxonomy of Viruses has named it Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (1). Three years later and after several epidemic waves, COVID-19 has infected about 650 000 000 people and 6 600 000 people have died

Study design

We conducted a retrospective observational study within 2 ICU of a university teaching hospital from March 2014 to March 2021 (Toulouse, France). Our institutional ethics committee (Direction de la Recherche et de l'Innovation, Toulouse University Hospital) approved the study (RnIPH 2020-75 - July 18th 2020) and waived the requirement for informed consent because the data were deidentified and the study posed no risk to participants. The study was realized in accordance with the ethical

Patients’ characteristics

Between 2014 and 2021, 363 patients were admitted to intensive care units at the Toulouse University Hospital for severe viral pneumonia: 152 (41.9%) patients for Influenza (between March 2014 and April 2019) and 211 (58.1%) for Covid-19 (between March 2020 and March 2021). The main characteristics of the patients are presented in table 1.

The characteristics of the patients highlighted a majority of patients with cardiovascular risk factors in the Covid-19 group, except for the over-represented

DISCUSSION

The mortality rates of patients with COVID-19 and influenza in the ICU were compared in an observational study, and no difference was found after adjusting for confounding factors using a propensity score. However, other studies have shown varying results, with some reporting excess mortality in COVID-19 patients (14, 19, 24) and others showing similar mortality rates between the two groups (18, 25, 26). It was observed that cardiovascular risk factors such as male sex, hypertension, obesity,

CONCLUSION

The study's findings suggest that, despite differences in clinical presentation and prognostic factors, mortality rates at 90 days after adjusting for confounding factors were similar between COVID-19 and influenza patients.

Uncited Floats

Figure 2

Uncited References

[1,2,31,32]

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

We would like to thank the entire Toulouse University Hospital intensive care unit, as well as the patients and their families. We thank Magali Centelles for her help in collecting patient data.

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