ABSTRACT
BACKGROUD: Management of severe COVID-19 patients admitted to ICU considerably evolved during the first months of the pandemic. It is unclear, however, whether these changes improved long-term survival of these critically ill patients. METHODS: We conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to a French ICU between February 2020 and January 2021, a timeframe that covered the first two waves of the pandemic. Primary outcome was to compare long-term survival between the first and second waves. Survival predictor were identified using a Cox proportional-hazards model. RESULTS: We included 265 patients in the cohort: 140 (52.8 %) and 125 (47.2 %) belonging to the first and second waves, respectively. Baseline characteristics of the patients were similar between the two waves. During W2, use of early corticotherapy increased (86.4% vs. 17.8 %; p <0.001), as well as high-flow oxygen therapy use (68.5% vs. 37.4 %; p<0.001). Need for invasive mechanical ventilation decreased (49.6% vs. 72.9 %; p <0.001) and ICU length of stay was shorter (11 [6-22] vs 19 [8-32]days; p = 0.008). ICU mortality was 32.8 % without significant difference between waves. Survival analysis revealed that 3 variables were independently associated with a worse long-term prognosis: a higher SAPS II score (1.05 [1.04-1.06]; p<0.001), a higher age (1.05 [1.01-1.08]; p = 0.005) and admission during W2 (2.22 [1.15-4.28]; p = 0.017). DISCUSSION: Despite substantial changes on management of severe COVID-19 patients, we observed a decreased long-term survival among patients admitted during the second wave. We also noted a shorter ICU length of stay.
Subject(s)
COVID-19 , Adult , Humans , COVID-19/epidemiology , COVID-19/therapy , Retrospective Studies , Intensive Care Units , Hospitalization , Respiration, ArtificialABSTRACT
"Treatment of lung cancer with immune checkpoints inhibitors .Immunotherapy has considerably changed the treatment of lung cancer. Anti-PD-1 or anti-PD-L1, either as monotherapy or in combination with chemotherapy, are now the cornerstone of the treatment of metastatic non-small cell lung cancer and enable some patients to achieve prolonged survival, sometimes without evidence of residual disease. Durvalumab has improved the survival of patients after treatment with chemo-radiotherapy for locally advanced NSCLC. The contribution of anti-PD(L)-1 in combination with chemotherapy is more modest in small cell cancers, although for the first time it has improved survival in extensive stage of the disease. The next step will be to integrate checkpoint inhibitors into the treatment of earlier forms of the disease."
Traitement des cancers du poumon par les inhibiteurs du contrôle immunitaire .L'immunothérapie a considérablement modifié la prise en charge du traitement des cancers pulmonaires. Les inhibiteurs de l'axe PD-1-PD-L1, soit en monothérapie, soit en combinaison avec la chimiothérapie, constituent désormais la pierre angulaire du traitement des cancers bronchopulmonaires non à petites cellules (CBNPC) d'emblée métastatiques et permettent à certains patients d'atteindre des survies prolongées parfois sans évidence de maladie résiduelle. Le durvalumab a permis d'améliorer la survie des patients après traitement par chimioradiothérapie pour une forme localement avancée de CBNPC. L'apport des anti-PD-L1 en combinaison avec la chimiothérapie est plus modeste dans les cancers à petites cellules, permettant cependant pour la première fois d'améliorer la survie des patients ayant des formes métastatiques. La prochaine étape consistera à intégrer les inhibiteurs du contrôle immunitaire dans le traitement des formes plus précoces de la maladie.
