Khalid Imran, Alshukairi Abeer N, Khalid Tabindeh Jabeen, Imran Maryam, Imran Manahil, Akhtar Muhammad Ali, Wali Ghassan Y
King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
John D Dingell VA Medical Center, Detroit, MI, USA.
Ann Thorac Med. 2022 Jan-Mar;17(1):59-65. doi: 10.4103/atm.atm_178_21. Epub 2022 Jan 14.
We conducted this study to evaluate the characteristics and outcomes exclusively in high-risk coronavirus disease 2019 (COVID-19) tertiary care patients with multiple comorbidities, as very few have reported outcomes in this specific cohort.
All patients, with two or more risk factors for COVID-19 and Charlson Comorbidity Index (CCI) of >2, who were admitted to intensive care unit (ICU) between March and December 2020 were included. Their characteristics, ICU course, and outcomes as well as differences between nonsurvivors and survivors were evaluated. The primary outcome was all-cause 28-day mortality.
Out of 1152 COVID-19 patients, 101 met the inclusion criteria. The patients had an average of 4 or more comorbidities with a very high CCI of 5. The 28-day all-cause mortality was 23% and inhospital mortality was 32%. Among all risk factors, only age > 70 years, male gender, and chronic kidney disease were significant determinants of mortality ( < 0.03). Admission PaO/FiO ratio and elevated inflammatory markers were same among survivors and nonsurvivors ( > 0.66). The mean time from presentation to ICU admission (59 vs. 38 h), APACHE II score (20.5 vs. 17), ICU length of stay (25 vs. 12 days), and hospital length of stay (28 vs. 20 days) were all higher in nonsurvivors as compared to survivors, respectively ( < 0.03). Fifty-four percent of the patients were intubated and had higher 28-day (40%) and inhospital (55%) mortality.
Tertiary care patients with multiple comorbidities have higher mortality than what is reported for mixed populations. Further studies are needed to determine realistic mortality benchmarks for these patients.
我们开展这项研究，专门评估患有多种合并症的高危2019冠状病毒病（COVID-19）三级护理患者的特征和结局，因为极少有研究报告这一特定队列的结局。
纳入2020年3月至12月期间入住重症监护病房（ICU）、具有两种或更多COVID-19风险因素且Charlson合并症指数（CCI）>2的所有患者。评估了他们的特征、ICU病程、结局以及非幸存者和幸存者之间的差异。主要结局是全因28天死亡率。
在1152例COVID-19患者中，101例符合纳入标准。这些患者平均有4种或更多合并症，CCI非常高，为5。28天全因死亡率为23%，住院死亡率为32%。在所有风险因素中，只有年龄>70岁、男性和慢性肾脏病是死亡率的显著决定因素（<0.03）。幸存者和非幸存者的入院时动脉血氧分压/吸入氧分数比值以及炎症标志物升高情况相同（>0.66）。与幸存者相比，非幸存者从就诊到入住ICU的平均时间（59小时对38小时）、急性生理与慢性健康状况评分系统II（APACHE II）评分（20.5对17）、ICU住院时间（25天对12天）和住院时间（28天对20天）均更高（<0.03）。54%的患者接受了气管插管，28天死亡率（40%）和住院死亡率（55%）更高。
患有多种合并症的三级护理患者的死亡率高于混合人群的报告死亡率。需要进一步研究来确定这些患者实际的死亡率基准。
