Vacheron Charles-Hervé, Bitker Laurent, Thiolliére Fabrice, Subtil Fabien, Abraham Paul, Collange Vincent, Balança Baptiste, Haïne Max, Guichon Céline, Leroy Christophe, Simon Marie, Malapert Amélie, Roche Mélanie, Pialat Jean-Baptiste, Jallades Laurent, Lepape Alain, Friggeri Arnaud, Falandry Claire
Department of Anaesthesiology and Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, Hospices Civils de Lyon, Villeurbanne, France; Division of Public Health, Department of Biostatistics and Bioinformatics, Lyon, France.
Department of Intensive Medicine and Resuscitation, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Turk J Anaesthesiol Reanim. 2022 Jun;50(Supp1):S57-S61. doi: 10.5152/TJAR.2022.21321.
Admission in the intensive care unit of the old patient with coronavirus disease 19 raises an ethical question concerning the scarce resources and their short-term mortality.
Patients aged over 60 from 7 different intensive care units admitted between March 1, 2020 and May 6, 2020, with a diagnosis of coronavirus disease 19 were included in the cohort. Twenty variables were collected during the admission, such as age, severity (Simplified Acute Physiology Score [SAPS] II), several data on physiological status before intensive care unit comorbidities, evaluation of autonomy, frailty, and biological variables. The objective was to model the 30-day mortality with relevant variables, compute their odds ratio associated with their 95% CI, and produce a nomogram to easily estimate and communicate the 30-day mortality. The performance of the model was estimated with the area under the receiving operating curve.
We included 231 patients, among them 60 (26.0%) patients have died on the 30th day. The relevant variables selected to explain the 30-day mortality were Instrumental Activities of Daily Living (IADL) score (0.82 [0.71-0.94]), age 1.12 (1.07-1.18), SAPS II 1.05 (1.02-1.08), and dementia 6.22 (1.00-38.58). A nomogram was computed to visually represent the final model. Area under the receiving operating curve was at 0.833 (0.776-0.889).
Age, autonomy, dementia, and severity at admission were important predictive variables for the 30-day mortality status, and the nomogram could help the physician in the decision-making process and the communication with the family.
老年新型冠状病毒肺炎患者入住重症监护病房引发了关于资源稀缺及其短期死亡率的伦理问题。
纳入2020年3月1日至2020年5月6日期间在7个不同重症监护病房收治的60岁以上确诊新型冠状病毒肺炎患者。入院时收集了20项变量，如年龄、严重程度（简化急性生理学评分[SAPS]II）、重症监护病房合并症之前的若干生理状态数据、自主性评估、衰弱情况及生物学变量。目的是用相关变量对30天死亡率进行建模，计算其与95%置信区间相关的比值比，并制作列线图以方便估计和传达30天死亡率。用受试者工作特征曲线下面积评估模型性能。
我们纳入了231例患者，其中60例（26.0%）患者在第30天死亡。用于解释30天死亡率的相关变量为日常生活活动能力（IADL）评分（0.82[0.71 - 0.94]）、年龄1.12（1.07 - 1.18）、SAPS II 1.05（1.02 - 1.08）和痴呆6.22（1.00 - 38.58）。计算了列线图以直观呈现最终模型。受试者工作特征曲线下面积为0.833（0.776 - 0.889）。
年龄、自主性、痴呆和入院时的严重程度是30天死亡状态的重要预测变量，列线图可帮助医生进行决策过程以及与家属沟通。
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