使用三种新的与医院占用率相关的指标评估 COVID-19 的病死率和变异风险监测。

Fatality assessment and variant risk monitoring for COVID-19 using three new hospital occupancy related metrics.

机构信息

Wilmer Eye Institute, Johns Hopkins University School of Medicine; Baltimore, MD, 21231, USA.

Wilmer Eye Institute, Johns Hopkins University School of Medicine; Baltimore, MD, 21231, USA; Department of Computer Science, University of Maryland at College Park (present affiliation).

出版信息

EBioMedicine. 2022 Sep;83:104225. doi: 10.1016/j.ebiom.2022.104225. Epub 2022 Aug 26.

DOI:10.1016/j.ebiom.2022.104225

PMID:36030648

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9415498/

Abstract

BACKGROUND

Though case fatality rate (CFR) is widely used to reflect COVID-19 fatality risk, its use is limited by large temporal and spatial variation. Hospital mortality rate (HMR) is also used to assess the severity of COVID-19, but HMR data is not directly available globally. Alternative metrics are needed for COVID-19 severity and fatality assessment.

METHODS

We introduce new metrics for COVID-19 fatality risk measurements/monitoring and a new mathematical model to estimate average hospital length of stay for deaths (L) and discharges (L). Multiple data sources were used for our analyses.

FINDINGS

We propose three, new metrics: hospital occupancy mortality rate (HOMR), ratio of total deaths to hospital occupancy (TDHOR), and ratio of hospital occupancy to cases (HOCR), for dynamic assessment of COVID-19 fatality risk. Estimated L and L for 501,079 COVID-19 hospitalizations in 34 US states between 7 August 2020 and 1 March 2021 were 18·2(95%CI:17·9-18·5) and 14·0(95%CI:13·9-14·0) days, respectively. We found the dramatic changes in COVID-19 CFR observed in 27 countries during early stages of the pandemic were mostly caused by undiagnosed cases. Compared to the first week of November 2021, the week mean HOCRs (mimics hospitalization-to-case ratio) for Omicron variant (58·6% of US new cases as of 25 December 2021) decreased 65·16% in the US as of 16 January 2022.

INTERPRETATION

The new and reliable measurements described here could be useful for COVID-19 fatality risk and variant-associated risk monitoring.

FUNDING

No specific funding was associated with the present study.

摘要

背景

尽管病死率（CFR）被广泛用于反映 COVID-19 的死亡风险，但由于其在时间和空间上存在较大差异，其应用受到限制。住院死亡率（HMR）也被用于评估 COVID-19 的严重程度，但 HMR 数据在全球范围内并不可用。因此需要替代指标来评估 COVID-19 的严重程度和死亡率。

方法

我们引入了 COVID-19 死亡率测量/监测的新指标和一种新的数学模型，以估计死亡（L）和出院（L）的平均住院时间。我们的分析使用了多种数据源。

发现

我们提出了三个新的指标：医院入住死亡率（HOMR）、总死亡人数与医院入住率之比（TDHOR）和医院入住人数与病例数之比（HOCR），用于动态评估 COVID-19 的死亡风险。我们估计了 2020 年 8 月 7 日至 2021 年 3 月 1 日期间美国 34 个州的 501079 例 COVID-19 住院患者的 L 和 L 分别为 18.2（95%CI：17.9-18.5）和 14.0（95%CI：13.9-14.0）天。我们发现，在大流行早期阶段，27 个国家观察到的 COVID-19 CFR 的急剧变化主要是由未确诊病例引起的。与 2021 年 11 月第一周相比，截至 2021 年 12 月 25 日，Omicron 变体（占美国新病例的 58.6%）在美国的每周平均 HOCR（模拟住院与病例之比）在 2022 年 1 月 16 日下降了 65.16%。