Kuwahara Masaatsu, Kamigaito Misa, Murakami Hiromoto, Sato Kiyoko, Mambo Naomi, Kobayashi Tomoyuki, Shirai Kunihiro, Miyawaki Atsushi, Ohya Munehiko, Hirata Jun-Ichi
Department of Emergency and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, JPN.
Cureus. 2022 May 26;14(5):e25374. doi: 10.7759/cureus.25374. eCollection 2022 May.
Aim There are few reports on the prognostic factors associated with mortality in coronavirus disease (COVID-19) patients with critical disease. This study assessed prognostic factors associated with mortality of patients with critical COVID-19 who required ventilator management. Methods This single-center, retrospective cohort study used medical record data of COVID-19 patients admitted to an emergency ICU at a hospital in Japan between March 1, 2020 and September 30, 2021, and provided with ventilator management. Multivariable logistic regression was used to identify factors associated with mortality. Results Seventy patients were included, of whom 29 (41.4%) died. The patients who died were significantly older (median: 69 years) (interquartile range [IQR]: 47-82 years) than the patients who survived (62 years [38-84 years], p<0.007). In addition, patients who died were significantly less likely to have received steroid therapy than patients who survived (25 [86.2%] vs. 41 [100%], p=0.026). In the multivariable analysis, age was identified as a significant prognostic factor for mortality and the risk of death increased by 6% for every one-year increase in age (OR: 1.06; 95% CI: 1.00-1.13; p=0.048). Medical history was not a risk factor for death. Conclusion Age was a predictor of mortality in critically ill patients with COVID-19. Therefore, the indications for critical care in older patients with COVID-19 should be carefully considered.
目的 关于危重型冠状病毒病(COVID-19)患者死亡相关预后因素的报道较少。本研究评估了需要呼吸机管理的危重型COVID-19患者死亡的预后因素。方法 本单中心回顾性队列研究使用了2020年3月1日至2021年9月30日期间在日本一家医院急诊重症监护病房收治并接受呼吸机管理的COVID-19患者的病历数据。采用多变量逻辑回归分析确定与死亡相关的因素。结果 共纳入70例患者,其中29例(41.4%)死亡。死亡患者的年龄显著大于存活患者(中位数:69岁)(四分位间距[IQR]:47 - 82岁)(存活患者为62岁[38 - 84岁],p<0.007)。此外,死亡患者接受类固醇治疗的可能性显著低于存活患者(25例[86.2%]对41例[100%],p = 0.026)。在多变量分析中,年龄被确定为死亡的显著预后因素,年龄每增加一岁,死亡风险增加6%(比值比:1.06;95%置信区间:1.00 - 1.13;p = 0.048)。病史不是死亡的危险因素。结论 年龄是危重型COVID-19患者死亡的预测因素。因此,对于老年COVID-19患者的重症监护指征应谨慎考虑。