Park Bryan D, Kannappan Arun, Rizzo Alicia N, Jin Ying, Peterson Ryan A, Burnham Ellen, Moss Marc, Jolley Sarah
Department of Internal Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO.
Department of Biostatistics and Informatics, Center for Innovative Design and Analysis, University of Colorado, Aurora, CO.
Crit Care Explor. 2022 Dec 5;4(12):e0791. doi: 10.1097/CCE.0000000000000791. eCollection 2022 Dec.
Colorado issued a month long statewide lockdown on March 26, 2020, during the initial surge of the COVID-19 pandemic. The impact of this mandate on non-COVID-19 ICU admission rates and outcomes is unclear.
We performed a retrospective analysis of all medical ICU admissions in the University of Colorado Health System in four predefined periods: 1) prepandemic (2 mo prior to lockdown period 1); 2) mandated lockdown from March 26 to April 26, 2020 (period 2); 3) between surges (period 3); and 4) nonmandated lockdown surge (between November 1, 2020, and March 31, 2021, period 4).
Nonsurgical ICU admissions at the University of Colorado Health Systems, including 10 hospitals throughout Colorado.
All ICU admissions in four predefined time periods.
We included 13,787 patients who were admitted during the four study periods. The 28-day mortality rates for non-COVID-19 ICU admissions following index ICU admission were 13.6%, 18.0%, 13.5%, and 16.0% across periods 1-4, respectively. However, the increased odds in non-COVID-19 ICU mortality during the mandated lockdown period relative to prepandemic 1 (odds ratio [OR], 1.39; 95% CI, 1.11-1.72; = 0.0.04) was attenuated and nonsignificant after adjustment for demographics, comorbidities, diagnosis flags, and severity (OR, 1.15; 95% CI, 0.89-1.48; = 0.27). Similar results were found in time-to-event analyses. The most common diagnosis in each time period was acute respiratory failure (ARF), and we found it to have increased during lockdown ( < 0.001), whereas sepsis admissions increased during and decreased after lockdown ( = 0.004). Admissions for alcohol withdrawal syndrome (AWS) increased during lockdown and 6 months afterwards ( = 0.005).
For non-COVID-19-related ICU admissions, mortality rate was similar before, during, and after Colorado's month long lockdown after confounder adjustment, including typical ICU admission flags. Primary admission diagnoses shifted throughout the predefined study periods with more admissions for severe critical diagnoses (i.e., ARF, sepsis, AWS) occurring during the mandated lockdown and nonmandated lockdown periods compared with the prepandemic and between surge period. This would suggest that the perceived increase in mortality during the lockdown for non-COVID-19 ICU admissions may be related to a shift inpatient demographics.
2020年3月26日，在新冠疫情初期激增阶段，科罗拉多州发布了为期一个月的全州封锁令。这项指令对非新冠重症监护病房（ICU）的入院率和治疗结果的影响尚不清楚。
我们对科罗拉多大学健康系统在四个预定义时期的所有内科ICU入院病例进行了回顾性分析：1）疫情前（封锁期1前2个月）；2）2020年3月26日至4月26日的强制封锁期（时期2）；3）两次激增之间（时期3）；4）非强制封锁激增期（2020年11月1日至2021年3月31日，时期4）。
科罗拉多大学健康系统的非手术ICU入院病例，包括科罗拉多州的10家医院。
四个预定义时间段内的所有ICU入院病例。
我们纳入了在四个研究时期入院的13787名患者。在第1 - 4时期，非新冠ICU入院病例在首次入住ICU后的28天死亡率分别为13.6%、18.0%、13.5%和16.0%。然而，与疫情前1相比，强制封锁期非新冠ICU死亡率增加的几率（优势比[OR]，1.39；95%置信区间[CI]，1.11 - 1.72；P = 0.04）在调整人口统计学、合并症、诊断标识和严重程度后减弱且无统计学意义（OR，1.15；95% CI，0.89 - 1.48；P = 0.27）。在生存时间分析中也发现了类似结果。每个时期最常见的诊断是急性呼吸衰竭（ARF），我们发现其在封锁期间有所增加（P < 0.001），而脓毒症入院病例在封锁期间增加，之后减少（P = 0.004）。酒精戒断综合征（AWS）的入院病例在封锁期间及之后6个月增加（P = 0.005）。
对于非新冠相关的ICU入院病例，在科罗拉多州为期一个月的封锁前后及期间，经混杂因素调整（包括典型的ICU入院标识）后，死亡率相似。主要入院诊断在预定义的研究时期内有所变化，与疫情前及激增期之间相比，在强制封锁期和非强制封锁期有更多严重危急诊断（即ARF、脓毒症、AWS）的入院病例。这表明，对于非新冠ICU入院病例，封锁期间死亡率的明显增加可能与住院患者人口统计学变化有关。
