COVID-19 危重症患者 70 岁以上人群的性别特异性治疗特征和 30 天死亡率结果-来自前瞻性 COVIP 研究。
Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study.
机构信息
Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
出版信息
Can J Anaesth. 2022 Nov;69(11):1390-1398. doi: 10.1007/s12630-022-02304-2. Epub 2022 Aug 9.
PURPOSE
Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort.
METHODS
We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality.
RESULTS
A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16).
CONCLUSION
In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality.
STUDY REGISTRATION
www.
CLINICALTRIALS
gov (NCT04321265); registered 25 March 2020).
目的
在持续的大流行中，患有 COVID-19 的老年重症患者一直是最脆弱的群体，男性比女性更容易住院和出现严重疾病。我们旨在探讨该队列中 ICU 入住后男女之间治疗和结局的具体差异。
方法
我们对纳入国际前瞻性多中心 COVIP 研究的年龄≥70 岁的患有 COVID-19 的重症患者进行了性别特异性分析。对所有患者进行 ICU 入住和治疗特征分析。我们进行了多层次调整回归分析，以阐明性别与 30 天死亡率的关联。
结果
共纳入 3159 例患者（69.8%为男性，30.2%为女性；中位年龄为 75 岁）。根据临床虚弱量表（健康，67%比 54%；脆弱，14%比 19%；虚弱，19%比 27%；P<0.001），男性患者明显比女性患者更健康。男性患者更常接受气管切开术（20%比 14%；优势比 [OR]，1.57；P<0.001）、血管加压治疗（69%比 62%；OR，1.25；P=0.02）和肾脏替代治疗（17%比 11%；OR，1.96；P<0.001）。男性和女性患者的机械通气、维持生命治疗限制和 30 天死亡率无差异（50%男性比 49%女性；OR，1.11；P=0.19），在调整疾病严重程度、虚弱程度、年龄和治疗限制后仍如此（OR，1.17；95%置信区间，0.94 至 1.45；P=0.16）。
结论
在这项对年龄≥70 岁的患有 COVID-19 的重症患者的性别特异性治疗特征和 30 天死亡率结局的分析中，我们发现男性患者比女性患者更常接受气管切开术和肾脏替代治疗，但患者性别与 30 天死亡率无显著关联。
研究注册
www.（NCT04321265）；于 2020 年 3 月 25 日注册）。
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