Isted Alexander, McDonnell Angus J, Jones Eben, Grundy Tomas, Jeyabraba Swarna, Ali Tariq O, Khorasanee Reza, Bhalla Aditya, Shurovi Badrun, Rowland Katie, Sykes Richard, Yoon Soo, Morillon Paul, Vijayakumar Rohini Salvadi, Clarke Jayson, Cox Charlie, Breeze Richard, Khaliq Waqas
Department of Intensive Care, University Hospital Lewisham, London, UK.
J Intensive Care Soc. 2022 Feb;23(1):34-43. doi: 10.1177/1751143720971541. Epub 2020 Nov 11.
In March 2020, Covid-19 secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared a global pandemic.
This retrospective observational study included patients with Covid-19, managed in a single intensive care unit (ICU). We collected data on patient characteristics, laboratory and radiological findings and ICU management. Data are reported as median (interquartile range). Binary logistic regression modelling was used to identify variables at ICU admission associated with mortality.
85 patients (age 57.3 years [49.4-64.2], 75.3% male) were followed up for 34 days (26-40). The commonest comorbidities were hypertension (51.8%), obesity (48.7%), and type 2 diabetes (31.8%). Covid-19 presented with shortness of breath (89.4%), fever (82.4%), and cough (81.2%), first noted 8 days (6-10) prior to ICU admission. PaO/FiO-ratios at ICU admission were 8.28 kPa (7.04-11.7). Bilateral infiltrates on chest X-ray, lymphopenia, and raised C-reactive protein and ferritin were typical. 81.2% received invasive mechanical ventilation (IMV). Acute kidney injury occurred in 62.4% with renal replacement therapy required in 20.0%. By the end of the follow-up period, 44.7% had died, 30.6% had been discharged from hospital, 14.1% had been discharged from ICU but remained in hospital and 10.6% remained in ICU. ICU length of stay was 14 days (9-23). Age was the only variable at admission which was associated with mortality. PaO/FiO-ratio, driving pressure and peak ferritin and neutrophil count over the first 72-hours of IMV all correlated with mortality.
We report the clinical characteristics, ICU practices and outcomes of a South London cohort with Covid-19, and have identified factors which correlate with mortality. By sharing our insight, we hope to further understanding of this novel disease.
2020年3月，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发的新冠肺炎被宣布为全球大流行。
这项回顾性观察研究纳入了在单一重症监护病房（ICU）接受治疗的新冠肺炎患者。我们收集了患者特征、实验室及影像学检查结果以及ICU管理的数据。数据报告为中位数（四分位间距）。采用二元逻辑回归模型确定入住ICU时与死亡率相关的变量。
85例患者（年龄57.3岁[49.4 - 64.2]，75.3%为男性）接受了34天（26 - 40）的随访。最常见的合并症为高血压（51.8%）、肥胖（48.7%）和2型糖尿病（31.8%）。新冠肺炎的表现为呼吸急促（89.4%）、发热（82.4%）和咳嗽（81.2%），首次出现症状是在入住ICU前8天（6 - 10）。入住ICU时的氧合指数（PaO/FiO）为8.28kPa（7.04 - 11.7）。胸部X线显示双侧浸润、淋巴细胞减少以及C反应蛋白和铁蛋白升高是其典型表现。81.2%的患者接受了有创机械通气（IMV）。62.4%的患者发生急性肾损伤，其中20.0%需要进行肾脏替代治疗。到随访期末，44.7%的患者死亡，30.6%的患者出院，14.1%的患者从ICU转出但仍住院，10.6%的患者仍在ICU。ICU住院时间为14天（9 - 23）。年龄是入住时唯一与死亡率相关的变量。IMV最初72小时内的氧合指数、驱动压、铁蛋白峰值和中性粒细胞计数均与死亡率相关。
我们报告了伦敦南部一组新冠肺炎患者的临床特征、ICU治疗情况及预后，并确定了与死亡率相关的因素。通过分享我们的见解，我们希望能增进对这种新型疾病的了解。
