Severn Deanery, Bristol, UK.
Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.
Anaesthesia. 2021 Apr;76(4):537-548. doi: 10.1111/anae.15425. Epub 2021 Feb 1.
The COVID-19 pandemic continues to cause critical illness and deaths internationally. Up to 31 May 2020, mortality in patients admitted to intensive care units (ICU) with COVID-19 was 41.6%. Since then, changes in therapeutics and management may have improved outcomes. Also, data from countries affected later in the pandemic are now available. We searched MEDLINE, Embase, PubMed and Cochrane databases up to 30 September 2020 for studies reporting ICU mortality among adult patients with COVID-19 and present an updated systematic review and meta-analysis. The primary outcome measure was death in intensive care as a proportion of completed ICU admissions, either through discharge from intensive care or death. We identified 52 observational studies including 43,128 patients, and first reports from the Middle East, South Asia and Australasia, as well as four national or regional registries. Reported mortality was lower in registries compared with other reports. In two regions, mortality differed significantly from all others, being higher in the Middle East and lower in a single registry study from Australasia. Although ICU mortality (95%CI) was lower than reported in June (35.5% (31.3-39.9%) vs. 41.6% (34.0-49.7%)), the absence of patient-level data prevents a definitive evaluation. A lack of standardisation of reporting prevents comparison of cohorts in terms of underlying risk, severity of illness or outcomes. We found that the decrease in ICU mortality from COVID-19 has reduced or plateaued since May 2020 and note the possibility of some geographical variation. More standardisation in reporting would improve the ability to compare outcomes from different reports.
COVID-19 大流行继续在国际上导致重症和死亡。截至 2020 年 5 月 31 日，入住重症监护病房（ICU）的 COVID-19 患者的死亡率为 41.6%。此后，治疗方法和管理方法的改变可能改善了结果。此外，现在也有来自大流行后期受影响国家的数据。我们在 2020 年 9 月 30 日之前在 MEDLINE、Embase、PubMed 和 Cochrane 数据库中搜索了报告 ICU 死亡率的成年 COVID-19 患者的研究，并进行了更新的系统评价和荟萃分析。主要结局指标是 ICU 死亡作为 ICU 出院或死亡的已完成 ICU 入院的比例。我们确定了 52 项观察性研究，包括 43128 名患者，以及来自中东、南亚和澳大拉西亚的首次报告，以及四项国家或地区登记处的报告。与其他报告相比，登记处报告的死亡率较低。在两个地区，死亡率与其他地区明显不同，中东地区较高，澳大拉西亚的单个登记处研究报告较低。尽管 ICU 死亡率（95%CI）低于 6 月报告的死亡率（35.5%（31.3-39.9%）比 41.6%（34.0-49.7%）），但缺乏患者水平的数据阻止了对其进行明确评估。报告缺乏标准化使得无法根据潜在风险、疾病严重程度或结局比较队列。我们发现，自 2020 年 5 月以来，COVID-19 导致的 ICU 死亡率下降或趋于平稳，并且注意到存在一些地域差异。报告的标准化程度提高将提高比较来自不同报告的结果的能力。
