COVID-19 患者入住 ICU 后机械通气和 ECMO 的危险因素：一项多中心回顾性观察研究。
Risk factors for mechanical ventilation and ECMO in COVID-19 patients admitted to the ICU: A multicenter retrospective observational study.
机构信息
Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.
出版信息
PLoS One. 2022 Nov 14;17(11):e0277641. doi: 10.1371/journal.pone.0277641. eCollection 2022.
BACKGROUND
The primary purpose of this study was to investigate risk factors associated with the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) in COVID-19 patients admitted to the intensive care unit (ICU).
METHODS
We retrospectively enrolled 66 consecutive COVID-19 patients admitted to the ICUs of three Japanese institutions from February 2020 to January 2021. We performed logistic regression analyses to identify risk factors associated with subsequent MV and ECMO requirements. Further, multivariate analyses were performed following adjustment for Acute Physiology and Chronic Health Evaluation (APACHE) II scores.
RESULTS
At ICU admission, the risk factors for subsequent MV identified were: higher age (Odds Ratio (OR) 1.04, 95% Confidence Interval (CI) 1.00-1.08, P = 0.03), higher values of APACHE II score (OR 1.20, 95% CI 1.08-1.33, P < 0.001), Sequential Organ Failure Assessment score (OR 1.53, 95% CI 1.18-1.97, P < 0.001), lactate dehydrogenase (LDH) (OR 1.01, 95% CI 1.00-1.02, p<0.001) and C-reactive protein (OR 1.09, 95% CI 1.00-1.19, P = 0.04), and lower values of lymphocytes (OR 1.00, 95% CI 1.00-1.00, P = 0.02) and antithrombin (OR 0.95, 95% CI 0.91-0.95, P < 0.01). Patients who subsequently required ECMO showed lower values of estimated glomerular filtration rate (OR 0.98, 95% CI 0.96-1.00, P = 0.04) and antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) at ICU admission. Multivariate analysis showed that higher body mass index (OR 1.19, 95% CI 1.00-1.40, P = 0.04) and higher levels of LDH (OR 1.01, 95% CI 1.01-1.02, P < 0.01) were independent risk factors for the need for MV. Lower level of antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) was a risk factor for the need for ECMO.
CONCLUSION
We showed that low antithrombin level at ICU admission might be a risk factor for subsequent ECMO requirements, in addition to other previously reported factors.
背景
本研究的主要目的是探讨与 COVID-19 患者入住重症监护病房（ICU）后需要机械通气（MV）和体外膜氧合（ECMO）相关的危险因素。
方法
我们回顾性纳入了 2020 年 2 月至 2021 年 1 月期间来自日本三家机构的 ICU 收治的 66 例连续 COVID-19 患者。我们进行了逻辑回归分析，以确定与随后 MV 和 ECMO 需求相关的危险因素。进一步，在调整急性生理学和慢性健康评估（APACHE）II 评分后进行了多变量分析。
结果
在 ICU 入院时，随后需要 MV 的危险因素包括：年龄较大（优势比（OR）1.04，95%置信区间（CI）1.00-1.08，P=0.03）、APACHE II 评分较高（OR 1.20，95%CI 1.08-1.33，P<0.001）、序贯器官衰竭评估评分（OR 1.53，95%CI 1.18-1.97，P<0.001）、乳酸脱氢酶（LDH）（OR 1.01，95%CI 1.00-1.02，P<0.001）和 C-反应蛋白（OR 1.09，95%CI 1.00-1.19，P=0.04）较高，以及淋巴细胞（OR 1.00，95%CI 1.00-1.00，P=0.02）和抗凝血酶（OR 0.95，95%CI 0.91-0.95，P<0.01）较低。随后需要 ECMO 的患者在 ICU 入院时显示出估计肾小球滤过率（OR 0.98，95%CI 0.96-1.00，P=0.04）和抗凝血酶（OR 0.94，95%CI 0.88-1.00，P=0.03）较低。多变量分析显示，较高的体重指数（OR 1.19，95%CI 1.00-1.40，P=0.04）和较高的 LDH 水平（OR 1.01，95%CI 1.01-1.02，P<0.01）是需要 MV 的独立危险因素。抗凝血酶水平较低（OR 0.94，95%CI 0.88-1.00，P=0.03）是需要 ECMO 的危险因素。
结论
我们表明，除了其他先前报道的因素外，入住 ICU 时的低抗凝血酶水平可能是随后需要 ECMO 的危险因素。
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