Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Health System, Detroit, MI.
Department of Internal Medicine, Henry Ford Health System, Detroit, MI.
Crit Care Med. 2021 Mar 1;49(3):482-489. doi: 10.1097/CCM.0000000000004735.
To investigate the potential influence of racial differences in outcomes of patients infected by coronavirus disease 2019-positive patients who require intensive care in an urban hospital.
Retrospective cohort study.
Henry Ford Health System Multidisciplinary ICU, a total of 156 beds spread throughout the hospital in Detroit, MI.
We obtained data from the electronic medical record of all adult severe acute respiratory syndrome coronavirus-2-positive patients managed in the ICU of Henry Ford Hospital in Detroit, MI, between March 13, 2020, and July 31, 2020. Included patients were divided into two groups: people of color (including Black, Asian, Hispanic/Latino, and Arab) and White.
None.
A total of 365 patients were evaluated: 219 were Black (60.0%), 129 were White (35.3%), two were Asian (0.6%), eight were Hispanic/Latino (2.2%), and seven were Arab (1.9%). People of color were younger (62.8 vs 67.1; p = 0.007), with equal distribution of sex. People of color had less coronary artery disease (34 [14.4%] vs 35 [27.1%]; p =0.003) and less self-reported use of regular alcohol consumption (50 [21.2%] vs 12 [9.3%]; p = 0.004) than Whites, with no differences in diabetes (125 [53.0%] vs 66 [51.2%]; p = 0.742), hypertension (188 [79.7%] vs 99 [76.8%]; p = 0.516), congestive heart failure (41 [17.4%] vs 32 [24.8%]; p = 0.090), or chronic kidney disease (123 [54.1%] vs 55 [42.6%]; p = 0.083).There was no difference in ICU length of stay between people of color (18 d [CI, 7-47 d]) and Whites (18 d [CI, 6-48 d]; p = 0. 0.979). Neither frequency (72.5% vs 71.3%; p = ns) nor median time to mechanical ventilation between people of color (9 d [CI, 6-15 d]) and Whites (10 d [CI, 5-16 d]; p = 0.733) was different. Overall, 188 patients (51.5 %) died in the hospital. The 28-day mortality was lower in people of color (107/236; 45.3%) versus Whites (73/129; 56.6%) (adjusted odds ratio 0.60; p = 0.034), and there was an increased median survival time in people of color (20 d) versus Whites (13.5 d; hazard ratio 0.62; p = 0.002). The inhospital mortality was lower in people of color versus White, but the difference was not statistically significant (113 [47.9%] vs 75 [58.1%], respectively; p = 0.061). Finally, there was no significant difference in days of symptoms prior to admission, frequency of presenting symptoms, or frequency or severity of acute respiratory distress syndrome between the two groups.
In critically ill patients infected with coronavirus disease 2019, people of color had a lower 28-day mortality than Whites with no difference in hospital mortality, ICU length of stay, or rates of intubation. These findings are contrary to previously held beliefs surrounding the pandemic.
研究在底特律市亨利福特医院多学科重症监护病房（共 156 张病床分布在医院各处）中，需要接受重症监护的新冠肺炎阳性患者种族差异对患者预后的潜在影响。
回顾性队列研究。
密歇根州底特律市亨利福特健康系统多学科 ICU。
我们从 2020 年 3 月 13 日至 7 月 31 日期间在底特律市亨利福特医院 ICU 接受管理的所有重症急性呼吸综合征冠状病毒 2 阳性成年患者的电子病历中获取数据。纳入患者分为两组：有色人种（包括黑人、亚洲人、西班牙裔/拉丁裔和阿拉伯人）和白人。
无。
共评估了 365 名患者：219 名是黑人（60.0%），129 名是白人（35.3%），2 名是亚洲人（0.6%），8 名是西班牙裔/拉丁裔（2.2%），7 名是阿拉伯人（1.9%）。有色人种患者更年轻（62.8 岁比 67.1 岁；p=0.007），性别分布均等。与白人相比，有色人种患者冠心病（34 例[14.4%]比 35 例[27.1%]；p=0.003）和自我报告的定期饮酒习惯（50 例[21.2%]比 12 例[9.3%]；p=0.004）较少，而糖尿病（125 例[53.0%]比 66 例[51.2%]；p=0.742）、高血压（188 例[79.7%]比 99 例[76.8%]；p=0.516）、充血性心力衰竭（41 例[17.4%]比 32 例[24.8%]；p=0.090）和慢性肾脏病（123 例[54.1%]比 55 例[42.6%]；p=0.083）无差异。有色人种（18 天[CI，7-47 天]）和白人（18 天[CI，6-48 天]；p=0.979）之间 ICU 住院时间无差异。有色人种（9 天[CI，6-15 天]）和白人（10 天[CI，5-16 天]；p=0.733）机械通气的频率（72.5%比 71.3%；p=ns）和中位时间也无差异。总体而言，188 名患者（51.5%）在医院死亡。28 天死亡率在有色人种（107/236；45.3%）低于白人（73/129；56.6%）（调整后的优势比 0.60；p=0.034），有色人种的中位生存时间延长（20 天）高于白人（13.5 天；危险比 0.62；p=0.002）。与白人相比，有色人种患者的院内死亡率较低，但差异无统计学意义（分别为 113 例[47.9%]和 75 例[58.1%]；p=0.061）。最后，两组患者入院前症状持续时间、出现症状的频率、急性呼吸窘迫综合征的频率或严重程度均无显著差异。
在感染新冠肺炎的重症患者中，与白人相比，有色人种的 28 天死亡率较低，但住院死亡率、ICU 住院时间或插管率无差异。这些发现与围绕大流行的先前观念相反。
