Snipelisky David, Johnson Rachel, Prasad Rajnish, Lakhani Baqir, Ellington Jeffrey
From the Department of Cardiovascular Medicine, Division of Advanced Heart Failure and Transplantation, the Department of Medicine, Division of Internal Medicine, the Department of Cardiovascular Medicine, Department of Critical Care Medicine, and the Department of Medicine, Division of Hospital Medicine, Wellstar Kennestone Medical Center, Marietta, Georgia.
South Med J. 2020 Dec;113(12):618-622. doi: 10.14423/SMJ.0000000000001182.
The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) epidemic is characterized by a global sense of uncertainty, partly driven by the paucity of real-life clinical data. This study assessed whether admission patient characteristics were associated with need for intensive care unit (ICU) care.
The observational study included consecutive patients admitted to a large community teaching hospital with a diagnosis of SARS-CoV-2 between March 6, 2020 and March 31, 2020. Comparisons were made based on the need for ICU admission.
A total of 156 patients were admitted, 42 of whom (26.9%) required ICU admission and 114 (73.1%) did not. No difference in age (61.9 years vs 60.5 years, = 0.67), race/ethnicity, or comorbidities were noted, except that patients requiring ICU care had lower serum albumin levels and lymphocyte counts and higher liver function tests, white blood cell count, and absolute neutrophil count on admission. The average time from admission to death was similar (10 days in an ICU subset vs 9.2 days in a non-ICU subset, = 0.78), yet patients necessitating ICU care had longer hospital lengths of stay (10.2 vs 5.1 days, = 0.0002). At the time of data extraction, 15 patients in the ICU had died, 7 were discharged from the hospital, and 20 were still admitted while 5 patients died in the non-ICU cohort with 97 discharged and 12 patients admitted.
This is the largest study assessing clinical differences based on the need for ICU admission in inpatients with SARS-CoV-2. It found few major differences in clinical variables between subsets. Among patients admitted to the ICU, outcomes were generally poor.
严重急性呼吸综合征冠状病毒2(SARS-CoV-2)疫情的特点是全球存在不确定性,部分原因是缺乏实际临床数据。本研究评估了入院患者特征与重症监护病房(ICU)护理需求之间是否存在关联。
这项观察性研究纳入了2020年3月6日至2020年3月31日期间连续入住一家大型社区教学医院且诊断为SARS-CoV-2的患者。根据是否需要入住ICU进行比较。
共收治156例患者,其中42例(26.9%)需要入住ICU,114例(73.1%)不需要。未发现年龄(61.9岁对60.5岁,P = 0.67)、种族/民族或合并症存在差异,但需要ICU护理的患者入院时血清白蛋白水平和淋巴细胞计数较低,肝功能检查、白细胞计数和绝对中性粒细胞计数较高。从入院到死亡的平均时间相似(ICU亚组为10天,非ICU亚组为9.2天,P = 0.78),但需要ICU护理的患者住院时间更长(10.2天对5.1天,P = 0.0002)。在数据提取时,ICU中有15例患者死亡,7例出院,20例仍在住院,而非ICU队列中有5例患者死亡,97例出院,12例仍在住院。
这是评估SARS-CoV-2住院患者基于ICU入院需求的临床差异的最大规模研究。研究发现亚组之间临床变量几乎没有重大差异。在入住ICU的患者中,结局通常较差。