Dachung Hospital, Miaoli, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 533, No. 17, Xu-Zhou Road, Taipei, 100, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 533, No. 17, Xu-Zhou Road, Taipei, 100, Taipei, Taiwan; Emergency Department of Taipei City Hospital, Ren-Ai Branch, Taiwan.
J Infect Public Health. 2021 Apr;14(4):504-507. doi: 10.1016/j.jiph.2020.12.026. Epub 2020 Dec 30.
There is a serious concern over the variation of case fatality of COVID-19 patients that reflects the preparedness of the medical care system in response to the surge of pneumonia patients. We aimed to quantify the disease spectrum of COVID-19 on which we are based to develop a key indicator on the probability of progression from pneumonia to acute respiratory disease syndrome (ARDS) for fatal COVID-19. The retrospective cohort on 12 countries that have already experienced the epidemic of COVID-19 with available open data on the conformed cases with detailed information on mild respiratory disease (MRD), pneumonia, ARDS, and deaths were used. The pooled estimates from three countries with detailed information were 73% from MRD to pneumonia and 27% from MRD to recovery and the case-fatality rate of ARDS was 43%. The progression from pneumonia to ARDS varied from 3% to 63%. These key estimates were highly associated with the case fatality rates reported for each country with a statistically significant positive relationship (adjusted R = 95%). Such a quantitative model provides key messages for the optimal medical resources allocation to a spectrum of patients requiring quarantine and isolation at home, isolation wards, and intensive care unit in order to reduce deaths from COVID-19.
人们对 COVID-19 患者病死率的差异表示严重关切，这反映了医疗系统应对肺炎患者激增的准备情况。我们旨在量化 COVID-19 的疾病谱，以此为基础制定一个关键指标，以预测肺炎向急性呼吸窘迫综合征（ARDS）进展的概率，从而导致 COVID-19 患者死亡。本研究使用了来自 12 个已经经历 COVID-19 疫情的国家的回顾性队列，这些国家有已公布的、包含详细轻度呼吸道疾病（MRD）、肺炎、ARDS 和死亡信息的确诊病例的公开数据。来自三个国家的详细信息汇总估计值为：73%的 MRD 进展为肺炎，27%的 MRD 进展为康复，ARDS 的病死率为 43%。从肺炎到 ARDS 的进展比例从 3%到 63%不等。这些关键估计值与每个国家报告的病死率密切相关，存在统计学显著的正相关关系（调整后的 R=95%）。这种定量模型为优化医疗资源分配提供了关键信息，以满足在家需要隔离和检疫、隔离病房和重症监护病房的一系列患者的需求，从而降低 COVID-19 的死亡率。
