Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom.
William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom.
PLoS One. 2020 Dec 15;15(12):e0243710. doi: 10.1371/journal.pone.0243710. eCollection 2020.
Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection.
We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival.
Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07-1.21]), obesity (OR 3.06 [95% CI 1.16-8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67-0.98]) and PaCO2 (OR 1.52 [95% CI 1.01-2.39]) were independently associated with ICU death.
Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK.
全球多个国家已经描述了患有 COVID-19 的重症患者队列，但迄今为止，来自英国（UK）的报告很少。了解在英国重症监护病房（ICU）接受治疗的受影响人群的特征对于指导临床决策、研究和规划未来的感染浪潮至关重要。
我们对 2020 年 3 月至 5 月期间在英国一家大型 ICU 收治的所有 COVID-19 患者进行了一项前瞻性观察队列研究，并随访至 2020 年 6 月。数据使用标准模板从病历中收集。我们使用多变量逻辑回归分析与 ICU 存活相关的因素。
在纳入的 156 名患者中，112 名（72%）为男性，89 名（57%）超重或肥胖，68 名（44%）为少数民族，89 名（57%）年龄超过 60 岁。136 名（87%）接受机械通气，77 名（气管插管者中的 57%）被置于俯卧位，95 名（气管插管者中的 70%）接受神经肌肉阻滞剂治疗。154 名（99%）患者需要心血管支持，44 名（28%）需要肾脏替代治疗。在 130 名完成 ICU 治疗的患者中，38 名（29%）死亡，92 名（71%）从 ICU 存活出院。在多变量模型中，年龄（OR 1.13 [95%CI 1.07-1.21]）、肥胖（OR 3.06 [95%CI 1.16-8.74]）、入院第一天的最低 P/F 比值（OR 0.82 [95%CI 0.67-0.98]）和 PaCO2（OR 1.52 [95%CI 1.01-2.39]）与 ICU 死亡独立相关。
在该队列中，年龄、肥胖和呼吸衰竭的严重程度是生存的关键决定因素。多器官衰竭很普遍。这些发现对于指导未来的研究很重要，在英国未来的医疗保健规划中应予以考虑。
