非中心疫区、中央监测医疗体系中 COVID-19 非 ICU 住院患者的临床特征和结局。
Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System.
机构信息
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Central Monitoring Unit, Cleveland Clinic Foundation, Cleveland, Ohio.
出版信息
J Hosp Med. 2021 Jan;16(1):7-14. doi: 10.12788/jhm.3510.
BACKGROUND
The clinical characteristics and outcomes associated with non-intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized.
METHODS
Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation.
RESULTS
Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis.
CONCLUSION
Among non-critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients.
背景
在疾病中心以外的地区，非重症监护病房（非 ICU）的 2019 年冠状病毒病（COVID-19）住院患者的临床特征和结局仍未得到很好的描述。
方法
对 2020 年 3 月 13 日至 5 月 1 日期间在一个大型美国医疗机构出院的所有 COVID-19 非 ICU 住院患者进行系统分析，利用远程监测。检查了感兴趣的变量与死亡、转入 ICU 或需要增加氧气至高流量鼻导管、无创通气或机械通气的复合事件发生率的关系。
结果
在 350 名患者（年龄 64±16 岁；55%为男性）中，大多数（73%）在入院时需要 3L/min 或更少的补充氧气。遥测技术得到了广泛应用（79%），但心律失常并不常见（14%），主要（90%）发生在肌钙蛋白水平异常或有已知心血管疾病的患者中。室性心动过速罕见（5%），为非持续型，与羟氯喹/阿奇霉素治疗无关。62 名患者（18%）发生不良事件，包括 22 例死亡（6%）、48 例转入 ICU（14%）和 49 例需要增加氧气的患者（14%），并与 C 反应蛋白升高（优势比，每增加 1mg/dL 为 1.09；95%CI，1.01-1.18；P =.04）和乳酸脱氢酶（OR，每增加 1U/L 为 1.006；95%CI，1.001-1.012；P =.03）独立相关。
结论
在非中心地区医疗系统住院的非危重症患者中，总体生存率为 94%，较严重疾病或死亡的发生与入院时 C 反应蛋白和乳酸脱氢酶水平升高独立相关。临床失代偿主要与呼吸系统相关，严重心律失常罕见，这表明遥测可优先用于高危患者。
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