Leafloor Cameron W, Imsirovic Haris, Qureshi Danial, Milani Christina, Nyarko Kwadjo, Dickson Sarah E, Thompson Laura, Tanuseputro Peter, Kyeremanteng Kwadwo
Department of Emergency Medicine, University of Ottawa Faculty of Medicine and The Ottawa Hospital, Ottawa, ON, Canada.
The Ottawa Hospital Research Institute and ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada.
Crit Care Explor. 2023 Mar 27;5(4):e0888. doi: 10.1097/CCE.0000000000000888. eCollection 2023 Apr.
Outcomes for critically ill COVID-19 are well described; however, the impact of the pandemic on critically ill patients without COVID-19 infection is less clear.
To demonstrate the characteristics and outcomes of non-COVID patients admitted to an ICU during the pandemic, compared with the previous year.
A population-based study conducted using linked health administrative data comparing a cohort from March 1, 2020, to June 30, 2020 (pandemic) to a cohort from March 1, 2019, to June 30, 2019 (nonpandemic).
Adult patients (18 yr old) admitted to an ICU in Ontario, Canada, without a diagnosis of COVID-19 during the pandemic and nonpandemic periods.
The primary outcome was all-cause in-hospital mortality. Secondary outcomes included hospital and ICU length of stay, discharge disposition, and receipt of resource intensive procedures (e.g., extracorporeal membrane oxygenation, mechanical ventilation, renal replacement therapy, bronchoscopy, feeding tube insertion, and cardiac device insertion). We identified 32,486 patients in the pandemic cohort and 41,128 in the nonpandemic cohort. Age, sex, and markers of disease severity were similar. Fewer patients in the pandemic cohort were from long-term care facilities and had fewer cardiovascular comorbidities. There was an increase in all-cause in-hospital mortality among the pandemic cohort (13.5% vs 12.5%; < 0.001) representing a relative increase of 7.9% (adjusted odds ratio, 1.10; 95% CI, 1.05-1.56). Patients in the pandemic cohort admitted with chronic obstructive pulmonary disease exacerbation had an increase in all-cause mortality (17.0% vs 13.2%; = 0.013), a relative increase of 29%. Mortality among recent immigrants was higher in the pandemic cohort compared with the nonpandemic cohort (13.0% vs 11.4%; = 0.038), a relative increase of 14%. Length of stay and receipt of intensive procedures were similar.
We found a modest increase in mortality among non-COVID ICU patients during the pandemic compared with a nonpandemic cohort. Future pandemic responses should consider the impact of the pandemic on all patients to preserve quality of care.
危重症新冠患者的预后已有详尽描述；然而，疫情对未感染新冠的危重症患者的影响尚不清楚。
对比疫情期间与上一年入住重症监护病房（ICU）的非新冠患者的特征及预后。
一项基于人群的研究，利用关联的卫生行政数据，将2020年3月1日至2020年6月30日（疫情期间）的队列与2019年3月1日至2019年6月30日（非疫情期间）的队列进行比较。
加拿大安大略省入住ICU的成年患者（≥18岁），在疫情期间和非疫情期间均未被诊断为新冠。
主要结局为全因住院死亡率。次要结局包括住院时间和ICU住院时间、出院处置情况，以及接受资源密集型治疗（如体外膜肺氧合、机械通气、肾脏替代治疗、支气管镜检查、插入饲管和插入心脏装置）。我们在疫情队列中识别出32486例患者，在非疫情队列中识别出41128例患者。年龄、性别和疾病严重程度指标相似。疫情队列中来自长期护理机构的患者较少，心血管合并症也较少。疫情队列中的全因住院死亡率有所上升（13.5%对12.5%；P<0.001），相对上升了7.9%（调整后的优势比，1.10；95%置信区间，1.05 - 1.56）。因慢性阻塞性肺疾病急性加重入住的疫情队列患者的全因死亡率有所上升（17.0%对13.2%；P = 0.013），相对上升了29%。与非疫情队列相比，疫情队列中近期移民的死亡率更高（13.0%对11.4%；P = 0.038），相对上升了14%。住院时间和接受强化治疗情况相似。
我们发现，与非疫情队列相比，疫情期间非新冠ICU患者的死亡率有适度上升。未来应对疫情时应考虑疫情对所有患者的影响，以保证医疗质量。
