Estella Á, Garcia Garmendia J L, de la Fuente C, Machado Casas J F, Yuste M E, Amaya Villar R, Estecha M A, Yaguez Mateos L, Cantón Bulnes M L, Loza A, Mora J, Fernández Ruiz L, Díez Del Corral Fernández B, Rojas Amezcua M, Rodriguez Higueras M I, Díaz Torres I, Recuerda Núñez M, Zaheri Beryanaki M, Rivera Espinar F, Matallana Zapata D F, Moreno Cano S G, Gimenez Beltrán B, Muñoz N, Sainz de Baranda Piñero A, Bustelo Bueno P, Moreno Barriga E, Rios Toro J J, Pérez Ruiz M, Gómez González C, Breval Flores A, de San José Bermejo Gómez A, Ruiz Cabello Jimenez M A, Guerrero Marín M, Ortega Ordiales A, Tejero-Aranguren J, Rodriguez Mejías C, Gomez de Oña J, de la Hoz C, Ocaña Fernández D, Ibañez Cuadros S, Garnacho Montero J
Intensive Care Unit, Hospital Universitario de Jerez, Jerez, Spain.
Intensive Care Unit, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain.
Med Intensiva (Engl Ed). 2022 Apr;46(4):179-191. doi: 10.1016/j.medine.2021.02.008.
The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators.
Prospective descriptive multicenter cohort study.
26 Intensive care units (ICU) from Andalusian region in Spain.
Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30.
None.
Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied.
495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor.
Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.
本研究的目的是确定与六周死亡率相关的风险因素，特别是通过分析抗病毒药物和免疫调节剂的作用。
前瞻性描述性多中心队列研究。
西班牙安达卢西亚地区的26个重症监护病房（ICU）。
纳入2020年3月8日至5月30日确诊为SARS-CoV-2感染的连续重症患者。
无。
分析的变量包括人口统计学、严重程度评分和临床状况。对支持治疗、药物使用和死亡率进行分析。采用单因素分析，随后进行多因素Cox回归并结合倾向评分分析。
共纳入495例患者，但其中73例因数据不完整被排除。因此，最终分析纳入422例患者。中位年龄为63岁，男性305例（72.3%）。ICU死亡率：144/422（34%）；14天死亡率：81/422（19.2%）；28天死亡率：121/422（28.7%）；6周死亡率：152/422（36.5%）。通过多因素Cox比例分析，与42天死亡率独立相关的因素包括年龄、APACHE II评分、ICU入院时SOFA评分>6、ICU入院时乳酸脱氢酶>470U/L、使用血管升压药、肾外净化、ICU入院72小时后淋巴细胞百分比<6.5%以及血小板减少症，而使用洛匹那韦/利托那韦是一个保护因素。
年龄、APACHE II、SOFA>6分，以及血管升压药需求或肾脏替代治疗已被确定为六周死亡率的预测因素。给予皮质类固醇激素在死亡率方面未显示出益处，托珠单抗治疗也是如此。洛匹那韦/利托那韦的使用被确定为一个保护因素。
