Riskcenter-IREA, Department of Econometrics, University of Barcelona, Barcelona, Spain.
CatSalut Care Management Direction, Generalitat de Catalunya, Barcelona, Spain.
PLoS One. 2022 May 4;17(5):e0267428. doi: 10.1371/journal.pone.0267428. eCollection 2022.
Bed occupancy in the ICU is a major constraint to in-patient care during COVID-19 pandemic. Diagnoses of acute respiratory infection (ARI) by general practitioners have not previously been investigated as an early warning indicator of ICU occupancy.
A population-based central health care system registry in the autonomous community of Catalonia, Spain, was used to analyze all diagnoses of ARI related to COVID-19 established by general practitioners and the number of occupied ICU beds in all hospitals from Catalonia between March 26, 2020 and January 20, 2021. The primary outcome was the cross-correlation between the series of COVID-19-related ARI cases and ICU bed occupancy taking into account the effect of bank holidays and weekends. Recalculations were later implemented until March 27, 2022.
Weekly average incidence of ARI diagnoses increased from 252.7 per 100,000 in August, 2020 to 496.5 in October, 2020 (294.2 in November, 2020), while the average number of ICU beds occupied by COVID-19-infected patients rose from 1.7 per 100,000 to 3.5 in the same period (6.9 in November, 2020). The incidence of ARI detected in the primary care setting anticipated hospital occupancy of ICUs, with a maximum correlation of 17.3 days in advance (95% confidence interval 15.9 to 18.9).
COVID-19-related ARI cases may be a novel warning sign of ICU occupancy with a delay of over two weeks, a latency window period for establishing restrictions on social contacts and mobility to mitigate the propagation of COVID-19. Monitoring ARI cases would enable immediate adoption of measures to prevent ICU saturation in future waves.
在 COVID-19 大流行期间，重症监护病房（ICU）的床位占用是限制住院治疗的主要因素。全科医生诊断的急性呼吸道感染（ARI）此前并未被视为 ICU 床位占用的预警指标。
利用西班牙加泰罗尼亚自治区的一个基于人群的中央医疗保健系统登记处，分析了全科医生诊断的与 COVID-19 相关的所有 ARI 病例，以及 2020 年 3 月 26 日至 2021 年 1 月 20 日期间加泰罗尼亚所有医院占用的 ICU 床位数量。主要结局是考虑到银行假日和周末的影响，对 COVID-19 相关 ARI 病例和 ICU 床位占用的系列进行交叉相关分析。后来，直到 2022 年 3 月 27 日，又进行了重新计算。
每周平均 ARI 诊断发病率从 2020 年 8 月的 252.7/100,000 上升到 2020 年 10 月的 496.5/100,000（2020 年 11 月的 294.2/100,000），而同期 COVID-19 感染患者占用的 ICU 床位数量从 1.7/100,000 上升到 3.5/100,000（2020 年 11 月的 6.9/100,000）。初级保健机构检测到的 ARI 发病率预测了 ICU 的床位占用情况，提前最大相关性为 17.3 天（95%置信区间 15.9 至 18.9）。
COVID-19 相关的 ARI 病例可能是 ICU 床位占用的一个新的预警信号，潜伏期超过两周，这是为了限制社会接触和流动性以减轻 COVID-19 传播而建立限制措施的潜伏期窗口。监测 ARI 病例将使我们能够在未来的浪潮中立即采取措施，防止 ICU 饱和。
