COVID-19 Across Pandemic Variant Periods: The Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study

Vikramjit Mukherjee, MD, FRCP; Radu Postelnicu, MD; Chelsie Parker, MS; Patrick S. Rivers, PhD; George L. Anesi, MD, MSCE, MBE; Adair Andrews, RN, MATD; Erin Ables, MA; Eric D. Morrell, MD, MA; David M. Brett-Major, MD, MPH; M. Jana Broadhurst, MD, PhD; J. Perren Cobb, MD; Amy Irwin, DNP, RN; Christopher J. Kratochvil, MD; Kelsey Krolikowski, BA; Vishakha K. Kumar, MD, MBA; Douglas P. Landsittel, PhD; Richard A. Lee, MD; Janice M. Liebler, MD; Leopoldo N. Segal, MD; Jonathan E. Sevransky, MD, MHS; Avantika Srivastava, MS; Timothy M. Uyeki, MD, MPH; Mark M. Wurfel, MD, PhD; David Wyles, MD; Laura E. Evans, MD, MSc; Karen Lutrick, PhD; Pavan K. Bhatraju, MD, MSc; on behalf of the Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group

doi:10.1097/CCE.0000000000001122

Critical Care Explorations (Jul 2024)

COVID-19 Across Pandemic Variant Periods: The Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study

Vikramjit Mukherjee, MD, FRCP,
Radu Postelnicu, MD,
Chelsie Parker, MS,
Patrick S. Rivers, PhD,
George L. Anesi, MD, MSCE, MBE,
Adair Andrews, RN, MATD,
Erin Ables, MA,
Eric D. Morrell, MD, MA,
David M. Brett-Major, MD, MPH,
M. Jana Broadhurst, MD, PhD,
J. Perren Cobb, MD,
Amy Irwin, DNP, RN,
Christopher J. Kratochvil, MD,
Kelsey Krolikowski, BA,
Vishakha K. Kumar, MD, MBA,
Douglas P. Landsittel, PhD,
Richard A. Lee, MD,
Janice M. Liebler, MD,
Leopoldo N. Segal, MD,
Jonathan E. Sevransky, MD, MHS,
Avantika Srivastava, MS,
Timothy M. Uyeki, MD, MPH,
Mark M. Wurfel, MD, PhD,
David Wyles, MD,
Laura E. Evans, MD, MSc,
Karen Lutrick, PhD,
Pavan K. Bhatraju, MD, MSc,
on behalf of the Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group

Affiliations

Vikramjit Mukherjee, MD, FRCP: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
Radu Postelnicu, MD: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
Chelsie Parker, MS: 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
Patrick S. Rivers, PhD: 3 Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ.
George L. Anesi, MD, MSCE, MBE: 4 Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Adair Andrews, RN, MATD: 5 Society of Critical Care Medicine, Mount Prospect, IL.
Erin Ables, MA: 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
Eric D. Morrell, MD, MA: 6 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
David M. Brett-Major, MD, MPH: 7 Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
M. Jana Broadhurst, MD, PhD: 8 Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE.
J. Perren Cobb, MD: 10 Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Amy Irwin, DNP, RN: 11 Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.
Christopher J. Kratochvil, MD: 8 Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE.
Kelsey Krolikowski, BA: 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
Vishakha K. Kumar, MD, MBA: 4 Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Douglas P. Landsittel, PhD: 12 Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY.
Richard A. Lee, MD: 13 Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, School of Medicine, Irvine, CA.
Janice M. Liebler, MD: 14 Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Leopoldo N. Segal, MD: 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
Jonathan E. Sevransky, MD, MHS: 15 Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA.
Avantika Srivastava, MS: 17 Institute of Implementation Science in Population Health, City University of New York, New York, NY.
Timothy M. Uyeki, MD, MPH: 18 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
Mark M. Wurfel, MD, PhD: 6 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
David Wyles, MD: 11 Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.
Laura E. Evans, MD, MSc: 6 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
Karen Lutrick, PhD: 3 Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ.
Pavan K. Bhatraju, MD, MSc: 6 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
on behalf of the Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group

DOI: https://doi.org/10.1097/CCE.0000000000001122
Journal volume & issue: Vol. 6, no. 7
p. e1122

Abstract

Read online

IMPORTANCE:. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has evolved through multiple phases in the United States, with significant differences in patient centered outcomes with improvements in hospital strain, medical countermeasures, and overall understanding of the disease. We describe how patient characteristics changed and care progressed over the various pandemic phases; we also emphasize the need for an ongoing clinical network to improve the understanding of known and novel respiratory viral diseases. OBJECTIVES:. To describe how patient characteristics and care evolved across the various COVID-19 pandemic periods in those hospitalized with viral severe acute respiratory infection (SARI). DESIGN:. Severe Acute Respiratory Infection-Preparedness (SARI-PREP) is a Centers for Disease Control and Prevention Foundation-funded, Society of Critical Care Medicine Discovery-housed, longitudinal multicenter cohort study of viral pneumonia. We defined SARI patients as those hospitalized with laboratory-confirmed respiratory viral infection and an acute syndrome of fever, cough, and radiographic infiltrates or hypoxemia. We collected patient-level data including demographic characteristics, comorbidities, acute physiologic measures, serum and respiratory specimens, therapeutics, and outcomes. Outcomes were described across four pandemic variant periods based on a SARS-CoV-2 sequenced subsample: pre-Delta, Delta, Omicron BA.1, and Omicron post-BA.1. SETTING:. Multicenter cohort of adult patients admitted to an acute care ward or ICU from seven hospitals representing diverse geographic regions across the United States. PARTICIPANTS:. Patients with SARI caused by infection with respiratory viruses. MAIN OUTCOMES AND RESULTS:. Eight hundred seventy-four adult patients with SARI were enrolled at seven study hospitals between March 2020 and April 2023. Most patients (780, 89%) had SARS-CoV-2 infection. Across the COVID-19 cohort, median age was 60 years (interquartile range, 48.0–71.0 yr) and 66% were male. Almost half (430, 49%) of the study population belonged to underserved communities. Most patients (76.5%) were admitted to the ICU, 52.5% received mechanical ventilation, and observed hospital mortality was 25.5%. As the pandemic progressed, we observed decreases in ICU utilization (94% to 58%), hospital length of stay (median, 26.0 to 8.5 d), and hospital mortality (32% to 12%), while the number of comorbid conditions increased. CONCLUSIONS AND RELEVANCE:. We describe increasing comorbidities but improved outcomes across pandemic variant periods, in the setting of multiple factors, including evolving care delivery, countermeasures, and viral variants. An understanding of patient-level factors may inform treatment options for subsequent variants and future novel pathogens.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

About the journal