Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic continues to stretch intensive care unit (ICU) capacity to its limits worldwide and optimizing management of critically ill COVID-19 patients remains urgently needed [1]. Fortunately, most ICUs deploy Electronic Health Records (EHRs) to routinely capture high-frequency clinical information. These data reflect the clinical practice variation resulting from the novelty of COVID-19 as well as the variation in patient characteristics and outcomes between centers [2, 3]. Therefore, these data may be employed to better understand the clinical course of COVID-19 and individualize treatment.
Given these considerations, a large-scale ICU data sharing collaboration in The Netherlands was initiated for the COVID-19 pandemic, resulting in the Dutch Data Warehouse (DDW, Fig. 1). While the database is growing, at this point, the DDW combines pseudonymized EHR data from 23 intensive care units covering the entire ICU admission of all adult COVID-19 patients treated in these ICUs. Collected data include data from monitoring and life support devices, demographics, medication, fluid balance, comorbidities, laboratory results, and outcomes. All parameters were manually reviewed by intensive care professionals and mapped to a common ontology. A software data pipeline converted units, filtered data entry errors, and calculated derived clinical parameters. Data validation was a continuous process including hospital data verification and visual inspection of distribution plots.
Overview of the Dutch Data Warehouse
Detailed patient characteristics and technical information on the DDW are available in the online supplementary material (OSM). So far, 1633 patients treated between March and October 2020 have been processed and added to the DDW, now containing over 120 million data points mapped to a common ontology of 875 parameter names. Median age was 65 years (IQR 56–72) and 27.8% of patients were female. Mortality in the ICU was 25.4% overall, and 29.7% for mechanically ventilated patients. Hospital mortality was 33.1% and 36% for mechanically ventilated patients (available for 14/23 hospitals). Diabetes (22.9%), chronic obstructive pulmonary disease (COPD, 97%), and any immunodeficiency (9%) were the most common comorbidities. 78% of patients were intubated during their ICU stay, with 76.4% of these patients intubated within 10 hours after ICU admission. Patients were mechanically ventilated for a median of 12.4 days (IQR 6.4–22.6 days), with a reintubation rate of 13.4% among extubated patients. About half (53.9%) of patients were proned at least once and 72% of patients were proned within 48 h. The readmission rate was 4.7%. Preliminary analyses of respiratory characteristics in the first 24 h of invasive mechanical ventilation show a median P/F ratio of 164 mmHg (IQR 133–205). Repiratory system compliance after intubation was low 36 ml/cmH2O (IQR 29–45) with 30.8% of patients showing further drops by day 7. Initial positive end expiratory pressure (PEEP) was 14 cmH2O (IQR 10–15) and tidal volumes were 6.6 ml/kg (IQR 6.2–7.1). Thus, the general clinical picture and treatment is reminiscent of classic acute respiratory distress syndrome (ARDS).
The DDW is among the largest highly granular COVID-19 EHR datasets with full admission data to date. Coverage of entire ICU admissions can enable analyses known from general large ICU data sets such as MIMIC [4] and AmsterdamUMCdb [5]. In addition, the DDW paves the way for nationwide large-scale ICU data sharing beyond COVID-19. Importantly, given the ongoing pandemic, the intensive care and data science community are encouraged to utilize these data to optimize clinical care. Therefore, the DDW is available for global collaboration through https://www.icudata.nl.
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Acknowledgements
The Dutch ICU Data Sharing Collaborators: From the coordinating group: Diederik Gommers, MD, PhD, Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands; Olaf L. Cremer, MD, PhD, Intensive Care, UMC Utrecht, Utrecht, The Netherlands; Rob J. Bosman, MD, ICU, OLVG, Amsterdam; Sebastiaan J.J. Vonk, MSc; Mattia Fornasa, PhD, Pacmed, Amsterdam, The Netherlands; Tomas Machado, Pacmed, Amsterdam, The Netherlands; Tariq Dam, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands; Nicolet F. de Keizer, PhD, Department of Clinical Informatics, Amsterdam UMC, Amsterdam, The Netherlands; Masoume Raeissi, PhD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands; Nardo J.M. van der Meer, MD, PhD, Intensive Care, Amphia Ziekenhuis, Breda en Oosterhout, The Netherlands; Sander Rigter, MD, Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands; Evert-Jan Wils, MD, PhD, Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Tim Frenzel, MD, PhD, Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Dave A. Dongelmans, MD, PhD, Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands; Remko de Jong, MD, Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands; Marco Peters, MD, Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands; Marlijn J.A Kamps, MD, The Netherlands, Intensive Care, Catharina Ziekenhuis Eindhoven; Dharmanand Ramnarain, MD, Intensive Care, ETZ Tilburg, Tilburg, The Netherlands; Ralph Nowitzky, MD, Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands; Fleur G.C.A. Nooteboom, MD, Intensive Care, Laurentius Ziekenhuis, Roermond, The Netherlands; Wouter de Ruijter, MD, PhD, Intensive Care, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands; Louise C. Urlings-Strop, MD, PhD, Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands; Ellen G.M. Smit, MD, Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands; Jannet Mehagnoul-Schipper, MD, PhD, Intensive Care, VieCuri Medisch Centrum, Venlo, The Netherlands; Tom Dormans, MD, PhD, Intensive care, Zuyderland MC, Heerlen, The Netherlands; Taco Houwert, MSc, Pacmed, Amsterdam, The Netherlands; Hidde Hovenkamp, MSc, Pacmed, Amsterdam, The Netherlands; Roberto Noorduijn Londono, MSc, Pacmed, Amsterdam, The Netherlands; Davide Quintarelli, MSc, Pacmed, Amsterdam, The Netherlands; Martijn G. Scholtemeijer, MSc, Pacmed, Amsterdam, The Netherlands; Aletta A. de Beer, MSc, Pacmed, Amsterdam, The Netherlands; Ari Ercole, MD, PhD, Department of Anaesthesia, University of Cambridge, Cambridge, United Kingdom; Mihaela van der Schaar, PhD, Van der Schaar Lab, Machine Learning and AI for Medicine, University of Cambridge, Cambridge, United Kingdom; Martijn Beudel, MD, PhD, Department of Neurology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands; Mark Hoogendoorn, PhD, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands; Armand R.J. Girbes, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands; Willem E. Herter, BSc, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands; Patrick J. Thoral, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands; From the Laboratory for Critical Care Computational Intelligence: Luca Roggeveen, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Fuda van Diggelen, MSc, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands; Ali el Hassouni, PhD, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands; David Romero Guzman, PhD, Quantitative Data Analytics Group, Department of Computer Sciences, Faculty of Science, VU University, Amsterdam, The Netherlands; Sandjai Bhulai, PhD, Analytics and Optimization Group, Department of Mathematics, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands; Dagmar Ouweneel, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Ronald Driessen, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Jan Peppink, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; H.J. de Grooth, MD, PhD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; G.J. Zijlstra, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; A.J. van Tienhoven, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Evelien van der Heiden, MD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Jan Jaap Spijkstra, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Hans van der Spoel, MD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Angelique de Man, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Thomas Klausch, PhD, Department of Clinical Epidemiology, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Heder de Vries, MD, Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; From Pacmed: Michael de Neree tot Babberich, Pacmed, Amsterdam, The Netherlands; Olivier Thijssens, Pacmed, Amsterdam, The Netherlands; Lot Wagemakers, Pacmed, Amsterdam, The Netherlands lot; Julie Berend, Pacmed, Amsterdam, The Netherlands; Virginia Ceni Silva, Pacmed, Amsterdam, The Netherlands; Bob Kullberg, Pacmed, Amsterdam, The Netherlands; From RCCnet: Leo Heunks, MD, PhD, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Nicole Juffermans, MD, PhD, Intensive Care Unit, OLVG, Amsterdam, The Netherlands; Arjan Slooter, Intensive Care, UMC Utrecht, Utrecht, The Netherlands; From collaborating hospitals sharing data which has been processed and added into the data warehouse: Thijs C.D. Rettig, MD, PhD, Department of Intensive Care, Amphia Ziekenhuis, Breda en Oosterhout, The Netherlands; M.C. Reuland, MD, Department of Intensive Care Medicine, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands; Laura van Manen, MD, Department of Intensive Care, BovenIJ Ziekenhuis, Amsterdam, The Netherlands; Leon Montenij, MD, PhD, Department of Anesthesiology, Pain Management and Intensive Care, Catharina Ziekenhuis Eindhoven, The Netherlands; Jasper van Bommel, MD, PhD, Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands; Roy van den Berg, Department of Intensive Care, ETZ Tilburg, Tilburg, The Netherlands; Ellen van Geest, Department of ICMT, Haga Ziekenhuis, Den Haag, The Netherlands; Anisa Hana, MD, PhD, Intensive Care, Laurentius Ziekenhuis, Roermond, The Netherlands; Suat Simsek, MD, PhD, Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands, Department of Internal Medicine, Amsterdam UMC, location VUmc; B. van den Bogaard, MD, PhD, ICU OLVG, OLVG, Amsterdam; Prof. Peter Pickkers, Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Pim van der Heiden, MD, PhD, Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands; Claudia (C.W.) van Gemeren, MD, Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands; Arend Jan Meinders, Department of Internal Medicine and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands; Martha de Bruin, MD, Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Emma Rademaker, MD, MSc, Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands; Frits (H.M.) van Osch, Department of Clinical Epidemiology, VieCuri Medisch Centrum, Venlo, The Netherlands; Martijn de Kruif, MD, PhD, Department of Pulmonology, Zuyderland MC, Heerlen, The Netherlands; From collaborating hospitals having shared data: Stefaan HA Hendriks, MD, Intensive Care, Albert Schweitzerziekenhuis, Dordrecht, The Netherlands; Nicolas Schroten, MD, Intensive Care, Albert Schweitzerziekenhuis, Dordrecht, The Netherlands; Age D. Boelens, MD, Anesthesiology, Antonius Ziekenhuis Sneek, The Netherlands; Klaas Sierk Arnold, MD, Anesthesiology, Antonius Ziekenhuis Sneek, The Netherlands; A. Karakus, MD, Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands; J.W. Fijen, MD PhD, Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands; Barbara Festen-Spanjer, MD, Intensive Care, Ziekenhuis Gelderse Vallei, Ede, The Netherlands; Sefanja Achterberg, MD, PhD, ICU, Haaglanden Medisch Centrum, Den Haag, The Netherlands; Judith Lens, ICU, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands; Jacomar van Koesveld, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands; Walter van den Tempel, Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, the Netherlands; Dr. Koen S. Simons, Department of Intensive Care, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands; Cornelis P.C. (Peter) de Jager, MD, PhD, Department of Intensive Care, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands; Evelien Oostdijk, MD, PhD, ICU, Maasstad Ziekenhuis Rotterdam; Joost Labout, MD, PhD, ICU, Maasstad Ziekenhuis Rotterdam; Bart van der Gaauw, ICU, SEH, BWC, Martiniziekenhuis, Groningen, The Netherlands; Auke C. Reidinga, ICU, Martiniziekenhuis, Groningen, The Netherlands; Peter Koetsier, Intensive Care, Medisch Centrum Leeuwarden, The Netherlands; Michael Kuiper, Intensive Care, Medisch Centrum Leeuwarden, The Netherlands; Alexander D. Cornet, MD, PhD, FRCP, Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands; Albertus Beishuizen, MD PhD, Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands; Paul de Jong, Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Dennis Geutjes, Department of Information Technology, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Harald J.Faber, MD, ICU, WZA, Assen, The Netherlands; Johan Lutisan, MD, ICU, WZA, Assen, The Netherlands; Gert Brunnekreef, MD, department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands; Ankie W.M.M. Koopman-van Gemert, MD, PhD, department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands; From collaborating hospitals having signed the data sharing agreement: Robert Entjes, Intensive Care, Adrz, Goes, The Netherlands; Remko van den Akker, Intensive Care, Adrz, Goes, The Netherlands; Bram Simons, MD, Intensive Care, Bravis Ziekenhuis, Bergen op Zoom en Roosendaal, The Netherlands; A.A. Rijkeboer, MD, ICU, Flevoziekenhuis, Almere, The Netherlands; Sesmu Arbous, MD, PhD, Intensivist, LUMC, Leiden, The Netherlands; Marcel Aries, MD, PhD, MUMC+, University Maastricht, Maastricht, The Netherlands; Niels C. Gritters van den Oever, MD, Intensive Care, Treant Zorggroep, Emmen, The Netherlands; Martijn van Tellingen, MD, EDIC, Department of Intensive Care Medicine, afdeling Intensive Care, ziekenhuis Tjongerschans, Heerenveen, The Netherlands.
Funding
Partially funded by Grants from ZonMw (project 10430012010003, file 50-55700-98-908), Zorgverzekeraars Nederland and the Corona Research Fund. The sponsors had no role in any part of the study.
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The members of the Dutch ICU Data Sharing Collaborators are listed in acknowledgement section.
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Fleuren, L.M., de Bruin, D.P., Tonutti, M. et al. Large-scale ICU data sharing for global collaboration: the first 1633 critically ill COVID-19 patients in the Dutch Data Warehouse. Intensive Care Med 47, 478–481 (2021). https://doi.org/10.1007/s00134-021-06361-x
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DOI: https://doi.org/10.1007/s00134-021-06361-x