国家重症监护室因 COVID-19 住院患者的结局和特征：基于登记的队列研究。
National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19: A registry-based cohort study.
机构信息
From the Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences (MSC, PJB, RÅ, HA), Department of Anaesthesia and Intensive Care, Vrinnevi Hospital, Norrköping, Department of Thoracic and Vascular Surgery, Medical and Health Sciences, Linköping University (LE), Department of Anaesthesia, Intensive Care and Perioperative Services, Umeå University Hospital, Umeå (RKB), Department of Public Health Reporting, Public Health Agency of Sweden (AT), Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience, Linköping University, Sweden (SM).
出版信息
Eur J Anaesthesiol. 2021 Apr 1;38(4):335-343. doi: 10.1097/EJA.0000000000001459.
BACKGROUND
Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission.
OBJECTIVE
To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19.
DESIGN
Registry-based cohort study with prospective data collection.
SETTING
Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease.
PARTICIPANTS
Adult patients admitted to Swedish ICUs.
EXPOSURES
Baseline characteristics, intensive care treatments and organ failures.
MAIN OUTCOMES AND MEASURES
The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death.
RESULTS
We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality.
CONCLUSIONS
Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities.
TRIAL REGISTRATION NO
NCT04462393.
背景
由于随访时间不同，COVID-19 患者入住重症监护病房（ICU）的死亡率尚不清楚。很少有全国性的数据可以比较 COVID-19 患者 ICU 入住后的危险因素、治疗和结局。
目的
评估瑞典 ICU 收治的 COVID-19 患者的基线特征、治疗和 30 天结局。
设计
基于登记的前瞻性数据收集队列研究。
地点
2020 年 3 月 6 日至 5 月 6 日期间，实验室确诊 COVID-19 疾病后入住瑞典 ICU 的成年患者。
参与者
入住瑞典 ICU 的患者。
暴露因素
基线特征、重症监护治疗和器官衰竭。
主要结局和测量指标
主要结局为 30 天全因死亡率。采用多变量模型确定潜在预测变量与死亡之间的独立关联。
结果
我们确定了 1563 例有完整 30 天随访的患者。30 天全因死亡率为 26.7%。中位年龄为 61 岁[52 至 69 岁]，简化急性生理学评分Ⅲ（SAPS III）为 53 分[46 至 59 分]，62.5%至少有一种合并症。入院时的 PaO2/FiO2 中位数为 97.5[75.0 至 140.6]mmHg，74.7%患有中重度急性呼吸衰竭。年龄、男性[校正优势比（aOR）1.5（1.1 至 2.2）]、SAPS III 评分[aOR 1.3（1.2 至 1.4）]、严重呼吸衰竭[aOR 3.0（2.0 至 4.7）]、特定 COVID-19 药物治疗[aOR 1.4（1.0 至 1.9）]和连续肾脏替代治疗[aOR 2.1（1.5 至 3.0）]与死亡率增加相关。除慢性肺部疾病外，合并症的存在与死亡率无独立相关性。
结论
尽管入院时存在严重低氧血症，但瑞典 ICU 收治的 COVID-19 患者的 30 天死亡率普遍低于之前的报告。死亡率由年龄、基线疾病严重程度、器官衰竭的存在和程度驱动，而不是预先存在的合并症。
试验注册
NCT04462393。
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