Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
Division of Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA.
Clin Infect Dis. 2022 Feb 11;74(3):416-426. doi: 10.1093/cid/ciab419.
We aimed to describe trends in adverse outcomes among patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between February and September 2020 within a national healthcare system.
We identified enrollees in the national United States Veterans Affairs healthcare system who tested positive for SARS-CoV-2 between 28 February 2020 and 30 September 2020 (n = 55 952), with follow-up extending to 19 November 2020. We determined trends over time in incidence of the following outcomes that occurred within 30 days of testing positive: hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and death.
Between February and July 2020, there were marked downward trends in the 30-day incidence of hospitalization (44.2% to 15.8%), ICU admission (20.3% to 5.3%), mechanical ventilation (12.7% to 2.2%), and death (12.5% to 4.4%), which subsequently plateaued between July and September 2020. These trends persisted after adjustment for sociodemographic characteristics, comorbid conditions, documented symptoms, and laboratory tests, including among subgroups of patients hospitalized, admitted to the ICU, or treated with mechanical ventilation. From February to September, there were decreases in the use of hydroxychloroquine (56.5% to 0%), azithromycin (48.3% to 16.6%), vasopressors (20.6% to 8.7%), and dialysis (11.6% to 3.8%) and increases in the use of dexamethasone (3.4% to 53.1%), other corticosteroids (4.9% to 29.0%), and remdesivir (1.7% to 45.4%) among hospitalized patients.
The risk of adverse outcomes in SARS-CoV-2-positive patients decreased markedly between February and July, with subsequent stabilization from July to September. These trends were not explained by changes in measured baseline patient characteristics and may reflect changing treatment practices or viral pathogenicity.
我们旨在描述 2020 年 2 月至 9 月期间，美国退伍军人事务部（VA）医疗体系内 SARS-CoV-2 检测阳性患者的不良结局趋势。
我们确定了 2020 年 2 月 28 日至 9 月 30 日期间，在全国退伍军人事务部医疗系统中 SARS-CoV-2 检测阳性的患者（n = 55952），随访至 2020 年 11 月 19 日。我们确定了在检测阳性后 30 天内发生以下结局的发生率随时间的变化趋势：住院、重症监护病房（ICU）入住、机械通气和死亡。
在 2020 年 2 月至 7 月期间，住院（44.2%至 15.8%）、ICU 入住（20.3%至 5.3%）、机械通气（12.7%至 2.2%）和死亡（12.5%至 4.4%）的 30 天发生率均呈明显下降趋势，随后在 2020 年 7 月至 9 月期间趋于平稳。这些趋势在调整社会人口统计学特征、合并症、有记录的症状和实验室检查后仍然存在，包括在住院、入住 ICU 或接受机械通气的患者亚组中。从 2 月到 9 月，羟氯喹的使用减少（56.5%至 0%）、阿奇霉素（48.3%至 16.6%）、血管加压素（20.6%至 8.7%）和透析（11.6%至 3.8%），而住院患者中地塞米松（3.4%至 53.1%）、其他皮质类固醇（4.9%至 29.0%）和瑞德西韦（1.7%至 45.4%）的使用增加。
在 2 月至 7 月期间，SARS-CoV-2 阳性患者的不良结局风险显著下降，随后从 7 月到 9 月稳定下来。这些趋势不能用测量的基线患者特征的变化来解释，可能反映了治疗实践或病毒致病性的变化。
