Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom.
Intensive Care, Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Crit Care Med. 2021 Jan 1;49(1):102-111. doi: 10.1097/CCM.0000000000004740.
To identify characteristics that predict 30-day mortality among patients critically ill with coronavirus disease 2019 in England, Wales, and Northern Ireland.
Observational cohort study.
A total of 258 adult critical care units.
A total of 10,362 patients with confirmed coronavirus disease 2019 with a start of critical care between March 1, 2020, and June 22, 2020, of whom 9,990 were eligible (excluding patients with a duration of critical care less than 24 hr or missing core variables).
The main outcome measure was time to death within 30 days of the start of critical care. Of 9,990 eligible patients (median age 60 yr, 70% male), 3,933 died within 30 days of the start of critical care. As of July 22, 2020, 189 patients were still receiving critical care and a further 446 were still in acute hospital. Data were missing for between 0.1% and 7.2% of patients across prognostic factors. We imputed missing data ten-fold, using fully conditional specification and continuous variables were modeled using restricted cubic splines. Associations between the candidate prognostic factors and time to death within 30 days of the start of critical care were determined after adjustment for multiple variables with Cox proportional hazards modeling. Significant associations were identified for age, ethnicity, deprivation, body mass index, prior dependency, immunocompromise, lowest systolic blood pressure, highest heart rate, highest respiratory rate, Pao2/Fio2 ratio (and interaction with mechanical ventilation), highest blood lactate concentration, highest serum urea, and lowest platelet count over the first 24 hours of critical care. Nonsignificant associations were found for sex, sedation, highest temperature, and lowest hemoglobin concentration.
We identified patient characteristics that predict an increased likelihood of death within 30 days of the start of critical care for patients with coronavirus disease 2019. These findings may support development of a prediction model for benchmarking critical care providers.
识别英格兰、威尔士和北爱尔兰因 2019 年冠状病毒病（COVID-19）而危重症的患者在 30 天内死亡的预测特征。
观察性队列研究。
共有 258 个成人重症监护病房。
共有 10362 例确诊的 COVID-19 患者，从 2020 年 3 月 1 日至 2020 年 6 月 22 日开始重症监护，其中 9990 例符合条件（不包括重症监护时间少于 24 小时或核心变量缺失的患者）。
主要结局是从开始重症监护到 30 天内的死亡时间。在 9990 例符合条件的患者中（中位年龄 60 岁，70%为男性），3933 例在开始重症监护后 30 天内死亡。截至 2020 年 7 月 22 日，仍有 189 例患者正在接受重症监护，另有 446 例仍在急性医院。在整个预后因素中，数据缺失率在 0.1%到 7.2%之间。我们使用完全条件指定进行了十倍数据插补，连续变量使用限制立方样条进行建模。使用 Cox 比例风险建模对多个变量进行调整后，确定候选预后因素与开始重症监护后 30 天内死亡时间之间的关联。在开始重症监护后的前 24 小时内，年龄、种族、贫困程度、体重指数、既往依赖、免疫功能低下、最低收缩压、最高心率、最高呼吸率、PaO2/Fio2 比值（与机械通气的交互作用）、最高血乳酸浓度、最高血清尿素和最低血小板计数等显著相关。性别、镇静、最高温度和最低血红蛋白浓度与死亡风险无显著相关性。
我们确定了预测 COVID-19 患者开始重症监护后 30 天内死亡可能性增加的患者特征。这些发现可能支持为基准测试重症监护提供者开发预测模型。
