Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
JAMA Netw Open. 2023 Apr 3;6(4):e239050. doi: 10.1001/jamanetworkopen.2023.9050.
Trends in COVID-19 severe outcomes have significant implications for the health care system and are key to informing public health measures. However, data summarizing trends in severe outcomes among patients hospitalized with COVID-19 in Canada are not well described.
To describe trends in severe outcomes among patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Active prospective surveillance in this cohort study was conducted from March 15, 2020, to May 28, 2022, at a sentinel network of 155 acute care hospitals across Canada. Participants included adult (aged ≥18 years) and pediatric (aged 0-17 years) patients hospitalized with laboratory-confirmed COVID-19 at a Canadian Nosocomial Infection Surveillance Program (CNISP)-participating hospital.
COVID-19 waves, COVID-19 vaccination status, and age group.
The CNISP collected weekly aggregate data on the following severe outcomes: hospitalization, admission to an intensive care unit (ICU), receipt of mechanical ventilation, receipt of extracorporeal membrane oxygenation, and all-cause in-hospital death.
Among 1 513 065 admissions, the proportion of adult (n = 51 679) and pediatric (n = 4035) patients hospitalized with laboratory-confirmed COVID-19 was highest in waves 5 and 6 of the pandemic compared with waves 1 to 4 (77.3 vs 24.7 per 1000 patient admissions). Despite this, the proportion of patients with positive test results for COVID-19 who were admitted to an ICU, received mechanical ventilation, received extracorporeal membrane oxygenation, and died were each significantly lower in waves 5 and 6 when compared with waves 1 through 4. Admission to the ICU and in-hospital all-cause death rates were significantly higher among those who were unvaccinated against COVID-19 when compared with those who were fully vaccinated (incidence rate ratio, 4.3 and 3.9, respectively) or fully vaccinated with an additional dose (incidence rate ratio, 12.2 and 15.1, respectively).
The findings of this cohort study of patients hospitalized with laboratory-confirmed COVID-19 suggest that COVID-19 vaccination is important to reduce the burden on the Canadian health care system as well as severe outcomes associated with COVID-19.
COVID-19 严重后果的趋势对医疗保健系统具有重要意义，是制定公共卫生措施的关键。然而，加拿大 COVID-19 住院患者严重后果趋势的数据总结描述得并不完善。
描述 COVID-19 大流行的头 2 年期间 COVID-19 住院患者严重后果的趋势。
设计、地点和参与者：本队列研究采用主动前瞻性监测，于 2020 年 3 月 15 日至 2022 年 5 月 28 日在加拿大 155 家急症护理医院的哨点网络进行。参与者包括在加拿大医院感染监测计划（CNISP）参与医院住院的成年（年龄≥18 岁）和儿科（年龄 0-17 岁）COVID-19 实验室确诊患者。
COVID-19 波、COVID-19 疫苗接种状态和年龄组。
CNISP 每周汇总以下严重后果的综合数据：住院、入住重症监护病房（ICU）、接受机械通气、接受体外膜氧合和全因院内死亡。
在 1513065 例住院中，与第 1 至 4 波相比，第 5 和第 6 波 COVID-19 大流行期间住院的成年（n=51679）和儿科（n=4035）患者的比例最高（每 1000 例患者住院中分别为 77.3 例和 24.7 例）。尽管如此，与第 1 至 4 波相比，第 5 和第 6 波 COVID-19 检测结果呈阳性并入住 ICU、接受机械通气、接受体外膜氧合和死亡的患者比例均显著降低。与完全接种疫苗或额外接种一剂疫苗的患者相比，未接种 COVID-19 疫苗的患者 ICU 入院率和院内全因死亡率均显著升高（发病率比分别为 4.3 和 3.9）或额外接种一剂疫苗（发病率比分别为 12.2 和 15.1）。
这项对 COVID-19 实验室确诊住院患者的队列研究结果表明，COVID-19 疫苗接种对于减轻加拿大医疗保健系统的负担以及 COVID-19 相关严重后果非常重要。
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