Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.
Department of Medicine, Anne Arundel Medical Center, Annapolis, MD, United States of America.
PLoS One. 2020 Aug 12;15(8):e0237558. doi: 10.1371/journal.pone.0237558. eCollection 2020.
The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.
To evaluate risk factors for severe illness.
Retrospective, observational case series.
Single-institution.
First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.
None.
Intensive care unit admission or death.
In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients.
At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.
Covid-19 大流行有可能使稀缺的临床资源不堪重负。必须确定重症的危险因素，以便进行有效的资源分配。
评估重症的危险因素。
回顾性、观察性病例系列。
单机构。
2020 年 3 月 1 日至 4 月 12 日期间因 Covid-19 住院的前 117 例连续患者。
无。
入住重症监护病房或死亡。
住院死亡率为 24.8%，平均总住院时间为 11.82 天（95%CI：10.01 至 13.63 天）。30.8%的患者需要入住重症监护病房，29.1%的患者需要机械通气。多变量回归确定了入院时所需的补充氧气量（OR：1.208，95%CI：1.011-1.443，p =.037）、痰液生成（OR：6.734，95%CI：1.630-27.812，p =.008）、胰岛素依赖型糖尿病（OR：11.873，95%CI：2.218-63.555，p =.004）和慢性肾脏病（OR：4.793，95%CI：1.528-15.037，p =.007）是入住重症监护病房或死亡的重要危险因素。在入住重症监护病房或死亡的 48 例患者中，42%的患者在入院后 3 天内死亡，71%的患者在入院后 6 天内死亡，88%的患者在入院后 9 天内死亡。
在我们的地区医疗中心，Covid-19 患者的平均住院时间接近 12 天，31%的患者需要重症监护，死亡率为 25%。入院时痰液生成增加、补充氧气需求增加以及患有胰岛素依赖型糖尿病或慢性肾脏病的患者可能有发生重症的风险增加。创建了一个具有出色鉴别能力的重症监护病房入住或死亡预测模型，可用于治疗决策和资源分配。早期识别有重症风险的患者可能会改善因 Covid-19 住院的患者的预后。
