Service Hygiène, Epidémiologie, Infectiovigilance et Prévention, Centre Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France.
PLoS One. 2021 Jan 27;16(1):e0243709. doi: 10.1371/journal.pone.0243709. eCollection 2021.
A new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analysing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients.
In this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients presenting from the community for their first admission were prospectively collected and analysed. Characteristics of patients hospitalized in medical ward to those admitted in ICU were compared using Mann-Whitney and Chi-square or Fisher exact test when appropriate. Univariate logistic regression was first used to identify variables on admission that were associated with the outcome i.e. admission to an ICU versus total hospital stay in a medical ward. Forward selection was then applied beginning with sex, age and temperature in the multivariable logistic regression model.
Of the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of ICU hospitalization with temperature (OR, 1.56 [95% CI, 1.06-2.28] per degree Celsius increase), oxygen saturation <90% (OR, 12.45 [95% CI, 5.27-29.4]), abnormal lung auscultation on admission (OR, 3.58 [95% CI, 1.58-8.11]), elevated level of CRP (OR, 2.7 [95% CI, 1.29-5.66for CRP>100mg/L vs CRP<10mg/L). and monocytopenia (OR, 3.28 [95% CI, 1.4-7.68]) were also associated with increasing odds of ICU hospitalization. Older patients were less likely to be hospitalized in ICU (OR, 0.17 [95%CI, 0.05-0.51].
Age and delay between onset of symptoms and hospital admission were associated with the risk of hospitalisation in ICU. Age being a fixed variable, interventions that shorten this delay would improve the prognosis of Covid-19 patients.
自 2019 年底以来，一种新型呼吸道病毒 SARS-CoV-2 已经出现并在全球范围内传播。本研究旨在分析住院 COVID-19 患者入院时的临床表现和与入住重症监护病房（ICU）相关的决定因素。
在这项前瞻性基于医院的研究中，前瞻性收集并分析了首次因社区就诊而住院的成年 COVID-19 患者的社会人口统计学、临床和生物学特征。使用 Mann-Whitney 和卡方或 Fisher 精确检验比较住院于普通病房和 ICU 的患者的特征。使用单变量逻辑回归首先确定与结局相关的入院时变量，即入住 ICU 与在普通病房的总住院时间。向前选择从性别、年龄和温度开始应用于多变量逻辑回归模型。
在 412 名患者中，325 名出院，87 名住院死亡。多变量回归显示，体温升高（每摄氏度增加 1.56[95%CI，1.06-2.28]）、氧饱和度<90%（OR，12.45[95%CI，5.27-29.4]）、入院时异常肺部听诊（OR，3.58[95%CI，1.58-8.11]）、CRP 水平升高（OR，2.7[95%CI，1.29-5.66，CRP>100mg/L 与 CRP<10mg/L 相比）和单核细胞减少症（OR，3.28[95%CI，1.4-7.68]）与 ICU 住院的几率增加相关。年龄较大的患者不太可能入住 ICU（OR，0.17[95%CI，0.05-0.51]）。
年龄和症状出现与住院之间的延迟与 ICU 住院风险相关。年龄是一个固定变量，缩短这一延迟的干预措施将改善 COVID-19 患者的预后。
