Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
J Investig Med. 2024 Feb;72(2):202-210. doi: 10.1177/10815589231220573. Epub 2024 Jan 5.
Comorbid conditions represent a major risk for severe illness among persons with COVID-19. Previously healthy people with COVID-19 can also develop severe illness, but are expected to have better outcomes than those with comorbid conditions. Nevertheless, recent data suggest that the former may have, counterintuitively, higher risk of death among those with non-COVID sepsis. However, the epidemiology and outcomes of previously healthy people among critically ill patients with COVID-19 are unknown. We used statewide data to identify intensive care unit (ICU) admissions aged ≥18 years in Texas with COVID-19 in 2020. Multilevel logistic regression was used to estimate the association of comorbid state with short-term mortality (defined as in-hospital mortality or discharge to hospice) overall and with higher illness severity among ICU admissions. Among 52,776 ICU admissions with COVID-19, 6373 (12.1%) were previously healthy. Short-term mortality among previously healthy ICU admissions and those with comorbidities was 16.9% versus 34.6%. On adjusted analyses, the odds of short-term mortality were lower among the previously healthy compared to those with comorbidities overall (adjusted odds ratio (aOR) 0.84 (95% CI: 0.73-0.98)), but did not differ among those with ≥3 organ dysfunctions (aOR 1.11 (95% CI: 0.84-1.46)) and the mechanically ventilated (aOR 0.87 (95% CI: 0.68-1.12)), while being higher among those with do-not-resuscitate status (aOR 1.40 (95% CI: 1.04-1.89)). Over one in eight ICU admissions with COVID-19 were previously healthy. Although being previously healthy was associated with lower risk of death compared to those with comorbidities overall, it had no prognostic advantage among the more severely ill.
合并症是 COVID-19 患者发生重症的主要危险因素。既往健康的 COVID-19 患者也可能发展为重症，但预计其预后要好于合并症患者。然而，最近的数据表明，在非 COVID 脓毒症患者中，前者的死亡风险可能更高，这与直觉相反。然而，在 COVID-19 危重症患者中，既往健康人群的流行病学和结局尚不清楚。我们使用全州范围内的数据，确定了 2020 年德克萨斯州年龄≥18 岁的 COVID-19 重症监护病房（ICU）住院患者。使用多水平逻辑回归估计合并症状态与短期死亡率（定义为院内死亡率或转至临终关怀）的相关性，以及 ICU 住院患者的更高疾病严重程度的相关性。在 52776 例 ICU 入住 COVID-19 的患者中，有 6373 例（12.1%）为既往健康者。既往健康的 ICU 入住患者和合并症患者的短期死亡率分别为 16.9%和 34.6%。在调整分析中，与合并症患者相比，既往健康患者的短期死亡率较低（调整后的优势比（aOR）0.84（95%CI：0.73-0.98）），但在≥3 个器官功能障碍（aOR 1.11（95%CI：0.84-1.46））和机械通气患者（aOR 0.87（95%CI：0.68-1.12））中差异无统计学意义，而在无复苏意愿患者（aOR 1.40（95%CI：1.04-1.89））中则较高。每 8 例 ICU 入住 COVID-19 的患者中就有 1 例以上为既往健康者。虽然与合并症患者相比，既往健康者的死亡风险较低，但在病情较重的患者中，这并没有预后优势。
