School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden.
Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden.
Crit Care Med. 2024 Aug 1;52(8):1194-1205. doi: 10.1097/CCM.0000000000006271. Epub 2024 Mar 28.
Some studies have examined survival trends among critically ill COVID-19 patients, but most were case reports, small cohorts, and had relatively short follow-up periods. We aimed to examine the survival trend among critically ill COVID-19 patients during the first two and a half years of the pandemic and investigate potential predictors across different variants of concern periods.
Prospective cohort study.
Swedish ICUs, between March 6, 2020, and December 31, 2022.
Adult COVID-19 ICU patients of 18 years old or older from the Swedish Intensive Care Register (SIR) that were linked to multiple other national registers.
Survival probability and predictors of COVID-19 death were estimated using Kaplan-Meier and Cox regression analysis. Of 8975 patients, 2927 (32.6%) died. The survival rate among COVID-19 critically ill patients appears to have changed over time, with a worse survival in the Omicron period overall. The adjusted hazard ratios (aHRs) comparing older and younger ages were consistently strong but slightly attenuated in the Omicron period. After adjustment, the aHR of death was significantly higher for men, older age (40+ yr), low income, and with comorbid chronic heart disease, chronic lung disease, impaired immune disease, chronic renal disease, stroke, and cancer, and for those requiring invasive or noninvasive respiratory supports, who developed septic shock or had organ failures ( p < 0.05). In contrast, foreign-born patients, those with booster vaccine, and those who had taken steroids had better survival (aHR = 0.87; 95% CI, 0.80-0.95; 0.74, 0.65-0.84, and 0.91, 0.84-0.98, respectively). Observed associations were similar across different variant periods.
In this nationwide Swedish cohort covering over two and a half years of the pandemic, ICU survival rates changed over time. Older age was a strong predictor across all periods. Furthermore, most other mortality predictors remained consistent across different variant periods.
一些研究已经研究了危重症 COVID-19 患者的生存趋势，但大多数是病例报告、小队列研究，且随访时间相对较短。我们旨在研究大流行的头两年半期间危重症 COVID-19 患者的生存趋势，并研究不同关注变体期间的潜在预测因素。
前瞻性队列研究。
瑞典 ICU，2020 年 3 月 6 日至 2022 年 12 月 31 日。
来自瑞典重症监护登记处（SIR）的年龄在 18 岁或以上的成年 COVID-19 ICU 患者，这些患者与多个其他国家登记处相关联。
使用 Kaplan-Meier 和 Cox 回归分析估计 COVID-19 死亡的生存概率和预测因素。在 8975 名患者中，2927 名（32.6%）死亡。COVID-19 危重症患者的生存率似乎随时间而变化，总体而言，在奥密克戎时期的生存率较差。与较年轻年龄相比，调整后的危险比（aHR）始终较强，但在奥密克戎时期略有减弱。调整后，男性、年龄较大（40 岁以上）、收入较低、患有慢性心脏病、慢性肺病、免疫功能障碍、慢性肾病、中风和癌症以及需要侵入性或非侵入性呼吸支持、发生感染性休克或器官衰竭的患者死亡的 aHR 显著较高（p<0.05）。相比之下，外国出生的患者、接种过加强疫苗的患者和服用过类固醇的患者的生存率更高（aHR=0.87；95%CI，0.80-0.95；0.74，0.65-0.84 和 0.91，0.84-0.98）。观察到的关联在不同变体时期相似。
在这项涵盖大流行两年半以上的全国性瑞典队列研究中，ICU 生存率随时间而变化。所有时期年龄较大都是一个强有力的预测因素。此外，大多数其他死亡率预测因素在不同变体时期保持一致。
