Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.
The Metis Foundation, San Antonio, TX 78216, USA.
Mil Med. 2023 Mar 20;188(3-4):541-546. doi: 10.1093/milmed/usac143.
Accurate accounting of coronavirus disease 2019 (COVID-19) critical care outcomes has important implications for health care delivery.
We aimed to determine critical care and organ support outcomes of intensive care unit (ICU) COVID-19 patients and whether they varied depending on the completeness of study follow-up or admission time period.
We conducted a systematic review and meta-analysis of reports describing ICU, mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) mortality. A search was conducted using PubMed, Embase, and Cochrane databases.We included English language observational studies of COVID-19 patients, reporting ICU admission, MV, and ICU case fatality, published from December 1, 2019 to December 31, 2020. We excluded reports of less than 5 ICU patients and pediatric populations. Study characteristics, patient demographics, and outcomes were extracted from each article. Subgroup meta-analyses were performed based on the admission end date and the completeness of data.
Of 6,778 generated articles, 145 were retained for inclusion (n = 60,357 patients). Case fatality rates across all studies were 34.0% (95% CI = 30.7%, 37.5%, P < 0.001) for ICU deaths, 47.9% (95% CI = 41.6%, 54.2%, P < 0.001) for MV deaths, 58.7% (95% CI = 50.0%, 67.2%, P < 0.001) for RRT deaths, and 43.3% (95% CI = 31.4%, 55.4%, P < 0.001) for extracorporeal membrane oxygenation deaths. There was no statistically significant difference in ICU and organ support outcomes between studies with complete follow-up versus studies without complete follow-up. Case fatality rates for ICU, MV, and RRT deaths were significantly higher in studies with patients admitted before April 31st 2020.
Coronavirus disease 2019 critical care outcomes have significantly improved since the start of the pandemic. Intensive care unit outcomes should be evaluated contextually (study quality, data completeness, and time) for the most accurate reporting and to effectively guide mortality predictions.
准确统计 2019 年冠状病毒病（COVID-19）重症监护结局对医疗保健服务具有重要意义。
我们旨在确定重症监护病房（ICU）COVID-19 患者的重症监护和器官支持结局，以及它们是否因研究随访的完整性或入院时间段而有所不同。
我们对描述 ICU、机械通气（MV）、肾脏替代治疗（RRT）和体外膜氧合（ECMO）死亡率的报告进行了系统评价和荟萃分析。我们使用 PubMed、Embase 和 Cochrane 数据库进行了搜索。我们纳入了 2019 年 12 月 1 日至 2020 年 12 月 31 日期间发表的、描述 COVID-19 患者 ICU 入院、MV 和 ICU 病死率的英语观察性研究。我们排除了 ICU 患者少于 5 例和儿科人群的报告。从每篇文章中提取研究特征、患者人口统计学和结局。根据入院截止日期和数据完整性进行亚组荟萃分析。
在 6778 篇生成的文章中，有 145 篇被保留纳入（n=60357 例患者）。所有研究的 ICU 病死率为 34.0%（95%CI=30.7%，37.5%，P<0.001），MV 病死率为 47.9%（95%CI=41.6%，54.2%，P<0.001），RRT 病死率为 58.7%（95%CI=50.0%，67.2%，P<0.001），ECMO 病死率为 43.3%（95%CI=31.4%，55.4%，P<0.001）。在有完整随访和无完整随访的研究中，ICU 和器官支持结局没有统计学上的显著差异。2020 年 4 月 31 日前入院患者的 ICU、MV 和 RRT 病死率明显更高。
自大流行开始以来，COVID-19 重症监护结局已显著改善。应根据研究质量、数据完整性和时间上下文评估 ICU 结局，以进行最准确的报告并有效指导死亡率预测。
