Domi Hisaya, Matsuura Hiroshi, Kuroda Maiko, Yoshida Motoharu, Yamamura Hitoshi
Osaka Prefectural Nakakawachi Emergency and Critical Care Center Higashiosaka Osaka Japan.
Acute Med Surg. 2021 Jul 12;8(1):e683. doi: 10.1002/ams2.683. eCollection 2021 Jan-Dec.
The aim of this study was to investigate the prognostic factors and evaluate the change in inflammatory markers of patients with coronavirus disease 2019 (COVID-19) requiring mechanical ventilation.
This retrospective observational study conducted from April 1, 2020, to February 18, 2021, included 97 adult patients who required mechanical ventilation for severe COVID-19 pneumonia and excluded nonintubated patients with a positive COVID-19 polymerase chain reaction test and those who had any obvious bacterial infection on admission. All patients were followed up to discharge or death. We obtained clinical information and laboratory data including levels of presepsin, interleukin-6, procalcitonin, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody every day. Poor outcome was defined as death or receiving a tracheostomy during hospitalization, and favorable outcome was defined as discharge after extubation.
Differences (median [interquartile range]) were detected in age (76 [70-82] versus 66 [55-74] years), day from the onset of first symptoms to admission for mechanical ventilation (5 [3-7] versus 10 [8-12] days), and P/F ratio (i.e., ratio of arterial oxygen concentration to the fraction of inspired oxygen) after intubation (186 [149-251] versus 236 [180-296]) in patients with poor outcome versus those with favorable outcome on admission. Serum SARS-CoV-2 antibody levels had already increased on admission in patients with favorable outcome. We determined the day from the onset of first symptoms to admission for mechanical ventilation to be one of the independent prognostic factors of patients with COVID-19 (adjusted odds ratio 0.69, confidence interval 0.56-0.85).
These results may contribute to understanding the mechanism of progression in severe COVID-19 and may be helpful in devising an effective therapeutic strategy.
本研究旨在调查2019冠状病毒病（COVID-19）需要机械通气患者的预后因素，并评估其炎症标志物的变化。
本回顾性观察性研究于2020年4月1日至2021年2月18日进行，纳入97例因重症COVID-19肺炎需要机械通气的成年患者，排除COVID-19聚合酶链反应检测呈阳性的非插管患者以及入院时有明显细菌感染的患者。所有患者随访至出院或死亡。我们每天获取临床信息和实验室数据，包括降钙素原、白细胞介素-6、前降钙素水平以及严重急性呼吸综合征冠状病毒2（SARS-CoV-2）抗体。不良结局定义为住院期间死亡或接受气管切开术，良好结局定义为拔管后出院。
不良结局患者与入院时良好结局患者相比，在年龄（76[70 - 82]岁对66[55 - 74]岁）、从首次症状出现到接受机械通气入院的天数（5[3 - 7]天对10[8 - 12]天）以及插管后的P/F比值（即动脉血氧浓度与吸入氧分数之比）（186[149 - 251]对236[180 - 296]）方面存在差异（中位数[四分位间距]）。良好结局患者入院时血清SARS-CoV-2抗体水平已经升高。我们确定从首次症状出现到接受机械通气入院的天数是COVID-19患者的独立预后因素之一（调整优势比0.69，置信区间0.56 - 0.85）。
这些结果可能有助于理解重症COVID-19的进展机制，并可能有助于制定有效的治疗策略。
