Department of Anesthesiology, 12225University of Colorado, School of Medicine, Aurora, CO, USA.
Department of Medicine, 12225University of Colorado, School of Medicine, Aurora, CO, USA.
J Intensive Care Med. 2021 Mar;36(3):271-276. doi: 10.1177/0885066620954806. Epub 2020 Sep 2.
The United States currently has more confirmed cases of COVID-19 than any other country in the world. Given the variability in COVID-19 testing and prevention capability, identifying factors associated with mortality in patients requiring mechanical ventilation is critical. This study aimed to identify which demographics, comorbidities, markers of disease progression, and interventions are associated with 30-day mortality in COVID-19 patients requiring mechanical ventilation.
Adult patients with a confirmed diagnosis of COVID-19 admitted to one of the health system's intensive care units and requiring mechanical ventilation between March 9, 2020 and April 1, 2020, were included in this observational cohort study. We used Chi-Square and Mann-Whitney U tests to compare patient characteristics between deceased and living patients and multiple logistic regression to assess the association between independent variables and the likelihood of 30-day mortality.
We included 85 patients, of which 20 died (23.5%) within 30 days of the first hospital admission. In the univariate analysis, deceased patients were more likely ≥60 years of age (p < 0.001), non-Hispanic (p = 0.026), and diagnosed with a solid malignant tumor (p = 0.003). Insurance status also differed between survivors and non-survivors (p = 0.019). Age ≥60 and malignancy had a 9.5-fold (95% confidence interval 1.4-62.3, p = 0.020) and 5.8-fold higher odds ratio (95% confidence interval 1.2-28.4, p = 0.032) for 30-day mortality after adjusted analysis using multivariable logistic regression, while other independent variables were no longer significant.
In our observational cohort study of 85 mechanically ventilated COVID-19 patients, age, and a diagnosis of a solid malignant tumor were associated with 30-day mortality. Our findings validate concerns for the survival of elderly and cancer patients in the face of the COVID-19 pandemic in the United States, where testing capabilities and preventative measures have been inconsistent. Preventative efforts geared to patients at risk for intensive care unit mortality from COVID-19 should be explored.
美国目前的新冠确诊病例比世界上任何其他国家都多。鉴于新冠检测和预防能力的差异，确定需要机械通气的患者死亡相关因素至关重要。本研究旨在确定哪些人口统计学、合并症、疾病进展标志物和干预措施与需要机械通气的新冠患者的 30 天死亡率相关。
本观察性队列研究纳入了 2020 年 3 月 9 日至 4 月 1 日期间入住本医疗系统的重症监护病房并需要机械通气的确诊新冠成年患者。我们使用卡方检验和曼-惠特尼 U 检验比较了死亡和存活患者的患者特征，并使用多因素逻辑回归评估了独立变量与 30 天死亡率的关联。
我们纳入了 85 例患者，其中 20 例（23.5%）在首次住院后 30 天内死亡。在单因素分析中，死亡患者更可能年龄≥60 岁（p<0.001）、非西班牙裔（p=0.026）和诊断为实体恶性肿瘤（p=0.003）。幸存者和非幸存者的保险状况也存在差异（p=0.019）。年龄≥60 岁和恶性肿瘤在调整多因素逻辑回归后的 30 天死亡率的优势比（95%置信区间 1.4-62.3，p=0.020）和 5.8 倍（95%置信区间 1.2-28.4，p=0.032）更高，而其他独立变量不再显著。
在我们对 85 例需要机械通气的新冠患者的观察性队列研究中，年龄和实体恶性肿瘤诊断与 30 天死亡率相关。我们的研究结果验证了美国在新冠大流行期间对老年和癌症患者生存的担忧，美国的检测能力和预防措施一直不一致。应探索针对有重症监护室死亡率风险的新冠患者的预防措施。
