Emory Critical Care Center (ECCC), Atlanta, GA.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Crit Care Med. 2022 Feb 1;50(2):245-255. doi: 10.1097/CCM.0000000000005185.
To determine the association between time period of hospitalization and hospital mortality among critically ill adults with coronavirus disease 2019.
Observational cohort study from March 6, 2020, to January 31, 2021.
ICUs at four hospitals within an academic health center network in Atlanta, GA.
Adults greater than or equal to 18 years with coronavirus disease 2019 admitted to an ICU during the study period (i.e., Surge 1: March to April, Lull 1: May to June, Surge 2: July to August, Lull 2: September to November, Surge 3: December to January).
Among 1,686 patients with coronavirus disease 2019 admitted to an ICU during the study period, all-cause hospital mortality was 29.7%. Mortality differed significantly over time: 28.7% in Surge 1, 21.3% in Lull 1, 25.2% in Surge 2, 30.2% in Lull 2, 34.7% in Surge 3 (p = 0.007). Mortality was significantly associated with 1) preexisting risk factors (older age, race, ethnicity, lower body mass index, higher Elixhauser Comorbidity Index, admission from a nursing home); 2) clinical status at ICU admission (higher Sequential Organ Failure Assessment score, higher d-dimer, higher C-reactive protein); and 3) ICU interventions (receipt of mechanical ventilation, vasopressors, renal replacement therapy, inhaled vasodilators). After adjusting for baseline and clinical variables, there was a significantly increased risk of mortality associated with admission during Lull 2 (relative risk, 1.37 [95% CI = 1.03-1.81]) and Surge 3 (relative risk, 1.35 [95% CI = 1.04-1.77]) as compared to Surge 1.
Despite increased experience and evidence-based treatments, the risk of death for patients admitted to the ICU with coronavirus disease 2019 was highest during the fall and winter of 2020. Reasons for this increased mortality are not clear.
确定新冠肺炎危重症成年患者住院时间与住院死亡率之间的关系。
2020 年 3 月 6 日至 2021 年 1 月 31 日的观察性队列研究。
亚特兰大学术医疗中心网络内的 4 家医院的 ICU。
研究期间入住 ICU 的年龄≥18 岁的新冠肺炎成年患者（即 1 期激增：3 月至 4 月；1 期平静：5 月至 6 月；2 期激增：7 月至 8 月；2 期平静：9 月至 11 月；3 期激增：12 月至 1 月）。
在研究期间入住 ICU 的 1686 例新冠肺炎患者中，全因住院死亡率为 29.7%。死亡率随时间显著不同：1 期激增时为 28.7%，1 期平静时为 21.3%，2 期激增时为 25.2%，2 期平静时为 30.2%，3 期激增时为 34.7%（p=0.007）。死亡率与 1）预先存在的危险因素（年龄较大、种族、族裔、较低的体重指数、较高的 Elixhauser 合并症指数、从疗养院入院）；2）入住 ICU 时的临床状况（较高的序贯器官衰竭评估评分、较高的 D-二聚体、较高的 C 反应蛋白）；和 3）ICU 干预（接受机械通气、血管加压素、肾脏替代治疗、吸入血管扩张剂）显著相关。在校正基线和临床变量后，与 1 期激增相比，在 2 期平静（相对风险，1.37[95%CI=1.03-1.81]）和 3 期激增（相对风险，1.35[95%CI=1.04-1.77]）期间入院的死亡率显著增加。
尽管经验增加和采用了循证治疗，但 2020 年秋季和冬季入住 ICU 的新冠肺炎患者的死亡风险最高。导致这种死亡率增加的原因尚不清楚。
