Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA.
J Hosp Med. 2022 Apr;17(4):252-258. doi: 10.1002/jhm.12805. Epub 2022 Mar 16.
We aimed to examine the role played by the COVID-19 infection in patients' death and to determine the proportion of patients for whom it was a major contributor to death.
We included patients ≥50 years old who were hospitalized with COVID-19 infection and died between March 1, 2020 and September 30, 2020 in a tertiary medical center. We considered COVID-19 infection to be a major cause for death if the patient had well-controlled medical conditions and death was improbable without coronavirus infection, and a minor cause for death if the patient had serious illnesses and had an indication for palliative care.
Among 243 patients, median age was 80 (interquartile intervals: 72-86) and 40% were female. One in two had moderate or severe frailty and 41% had dementia. Nearly 60% of the patients were classified as having advanced, serious illnesses present prior to the hospitalization, with death being expected within 12 months, and among this group 39% were full code at admission. In the remaining 40% of patients, deaths were classified as unexpected based on patients' prior conditions, suggesting that COVID-19 infection complications were the primary contributor to death.
For slightly less than half (40%) of patients who died of complications of COVID-19, death was an unexpected event. Among the 60% of patients for whom death was not a surprise, our findings identify opportunities to improve end-of-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization.
我们旨在研究 COVID-19 感染在患者死亡中的作用，并确定其是导致患者死亡的主要原因的比例。
我们纳入了 2020 年 3 月 1 日至 2020 年 9 月 30 日期间在一家三级医疗中心住院的 COVID-19 感染且死亡的≥50 岁患者。如果患者的医疗状况得到良好控制，且没有冠状病毒感染则死亡的可能性较小，则认为 COVID-19 感染是导致死亡的主要原因；如果患者患有严重疾病且需要姑息治疗，则认为 COVID-19 感染是导致死亡的次要原因。
在 243 名患者中，中位年龄为 80 岁（四分位间距：72-86），40%为女性。近一半（50%）患者有中度或重度衰弱，41%有痴呆。近 60%的患者被归类为患有在住院前存在的晚期、严重疾病，预计在 12 个月内死亡，其中 39%在入院时是全面复苏（指除心肺复苏外，还包括脑复苏等一系列复苏措施）；在其余 40%的患者中，根据患者先前的病情，死亡被归类为意外事件，这表明 COVID-19 感染并发症是导致死亡的主要原因。
对于近一半（40%）死于 COVID-19 并发症的患者，死亡是一个意外事件。对于 60%的死亡并非意料之中的患者，我们的研究结果确定了机会，可以改善高危患者的临终讨论，并在早期或在住院前就实施风险共担决策。
