印度COVID-19登记处中需要入住重症监护病房的COVID-19患者的预测因素和结局分析。
Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India.
作者信息
Kajal Kamal, Singla Karan, Puri Goverdhan Dutt, Bhalla Ashish, Mukherjee Aparna, Kumar Gunjan, Turuk Alka, Premkumar Madhumita, Mahajan Varun, Naik Naveen B, Bingi Thrilok Chander, Bhardwaj Pankaj, John Mary, Menon Geetha R, Sahu Damodar, Panda Samiran, Rao Vishnu Vardhan
机构信息
Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Indian J Crit Care Med. 2023 Aug;27(8):552-562. doi: 10.5005/jp-journals-10071-24496.
BACKGROUND
Patients admitted to intensive care units (ICUs) with severe coronavirus disease (COVID-19) are associated with high mortality. The present retrospective, multicenter study describes the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian Council of Medical Research (ICMR), India.
MATERIALS AND METHODS
Prospectively collected data from participating institutions were entered into the electronic National Clinical Registry of COVID-19. We enrolled patients aged >18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative in RT-PCR report, death within 24 hours of ICU admission, or incomplete data. Their demographic and laboratory variables, ICU severity indices, treatment strategies, and outcomes were analyzed.
RESULTS
A total of 5,865 patients were enrolled. Overall mortality was 43.2%. Non-survivors were older (58.2 ± 15.4 vs 53.6 ± 14.7 years; = 0.001), had multiple comorbidities (33.2% vs 29.5%, = 0.001), had higher median D-dimer (1.56 vs 1.37, = 0.015), higher CT severity index (16.8 ± 5.2 vs 13.5 ± 5.47, = 0.001) and longer median hospital stay (10 vs 8 days, = 0.001) and ICU stay (5 vs 4 days, = 0.001), compared with survivors.On multivariate analysis, high CRP (HR 1.008, 95% CI: 1.006-1.010, = 0.001) and high D-dimer (HR 1.089, 95% CI: 1.065-1.113, < 0.001) were associated with invasive mechanical ventilation while older age (HR 1.19, CI: 1.001-1.038, = 0.039) and high D-dimer (HR-1.121, CI: 1.072-1.172, = 0.001) were independently associated with mortality and while the use of prophylactic low molecular weight heparin (LMWH) (HR 0.647, CI: 0.527-0.794, = 0.001) lowered mortality.
CONCLUSION
Among 5,865 COVID-19 patients admitted to ICU, mortality was 43.5%. High CRP and D-dimers were independently associated with the need for invasive mechanical ventilation while older age and high D-dimer were associated with higher mortality. The use of prophylactic LMWH independently reduced mortality.
HOW TO CITE THIS ARTICLE
Kajal K, Singla K, Puri GD, Bhalla A, Mukherjee A, Kumar G, . Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India. Indian J Crit Care Med 2023;27(8):552-562.
背景
因严重冠状病毒病（COVID-19）入住重症监护病房（ICU）的患者死亡率很高。本项回顾性多中心研究描述了来自印度医学研究理事会（ICMR）的COVID-19登记处中需要入住ICU的COVID-19患者的预测因素和结局。
材料与方法
将参与机构前瞻性收集的数据录入电子国家COVID-19临床登记处。我们纳入了2020年3月至2021年8月期间年龄>18岁、因COVID-19肺炎需要入住ICU的患者。排除标准为RT-PCR报告阴性、入住ICU后24小时内死亡或数据不完整。分析了他们的人口统计学和实验室变量、ICU严重程度指数、治疗策略及结局。
结果
共纳入5865例患者。总体死亡率为43.2%。非幸存者年龄更大（58.2±15.4岁对53.6±14.7岁；P=0.001），有多种合并症（33.2%对29.5%，P=0.001），D-二聚体中位数更高（1.56对1.37，P=0.015），CT严重程度指数更高（16.8±5.2对13.5±5.47，P=0.001），住院中位数更长（10天对8天，P=0.001），ICU住院时间更长（5天对4天，P=0.001），与幸存者相比。多因素分析显示，高CRP（HR 1.008，95%CI：1.006-1.010，P=0.001）和高D-二聚体（HR 1.089，95%CI：1.065-1.113，P<0.001）与有创机械通气相关，而年龄较大（HR 1.19，CI：1.001-1.038，P=0.039）和高D-二聚体（HR 1.121，CI：1.072-1.172，P=0.001）与死亡率独立相关，而使用预防性低分子量肝素（LMWH）（HR 0.647，CI：0.527-0.794，P=0.001）可降低死亡率。
结论
在5865例入住ICU的COVID-19患者中，死亡率为43.5%。高CRP和D-二聚体与有创机械通气需求独立相关，而年龄较大和高D-二聚体与较高死亡率相关。预防性使用LMWH可独立降低死亡率。
如何引用本文
卡贾尔·K、辛格拉·K、普里·G·D、巴拉拉·A、慕克吉·A、库马尔·G等。印度COVID-19登记处中需要入住ICU的COVID-19患者的预测因素和结局分析。《印度重症监护医学杂志》2023；27(8)：552-562。
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