Área de Gestión Sanitaria Campo de Gibraltar Oeste, Hospital Punta de Europa, Algeciras, Spain.
Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain.
Medicine (Baltimore). 2024 May 24;103(21):e38266. doi: 10.1097/MD.0000000000038266.
During the severe acute respiratory syndrome coronavirus 2 pandemic, hospital resources, particularly critical care units, were overburdened and this had a significant impact on both the therapies and the prognosis of these patients. This study aimed to identify factors and therapies that may improve prognosis and other factors associated with increased mortality. A secondary objective was to evaluate the impact that obesity had on these patients. An observational study was conducted on 482 patients aged 18 years or older who were diagnosed with SARS-CoV-2 pneumonia and admitted to the Intensive Care Units of 3 national hospitals registered in the CIBERESUCICOVID database between September 2020 and March 2021. After identifying the sample profile, risk factors were analyzed, the predictive model was constructed, and crude odd ratios were calculated for each factor. Additionally, logistic regression was used to build the multivariate model adjusting for potential confounders. The final model included only the variables selected using the Backward method. A sample of 335 men (69.5%) and 145 women (30.08%) aged 61.94 ± 12.75 years with a body mass index (BMI) of 28.05 (25.7; 31.2) was obtained. A total of 113 patients received noninvasive mechanical ventilation. The most common comorbidities were: high blood pressure (51.04%), obesity (28%), diabetes mellitus (23.44%), other metabolic diseases (21.16%), chronic heart failure (18.05%), chronic obstructive pulmonary disease (11.62%), and chronic kidney disease (10.16%). In-hospital, 3-month and 6-month post-discharge mortality in patients with BMI > 30 (n = 135) versus BMI ≤ 30 (n = 347) was significantly different (P = .06). Noninvasive mechanical ventilation failed in 42.4% of patients with BMI > 30 compared to 55% of patients with BMI ≤ 30. This study identified the factors associated with failure of mechanical ventilation. The most common comorbidities were congestive heart failure, high blood pressure, chronic kidney disease, severe liver disease, diabetes mellitus, and solid organ transplantation. In terms of ventilatory support, patients who received high-flow nasal oxygen therapy on admission had lower mortality rates. The use of renal replacement therapy was also significantly associated with higher mortality.
在严重急性呼吸综合征冠状病毒 2 大流行期间，医院资源，特别是重症监护病房，负担过重，这对这些患者的治疗和预后都有重大影响。本研究旨在确定可能改善预后的因素和治疗方法，以及与死亡率增加相关的其他因素。次要目标是评估肥胖对这些患者的影响。对 2020 年 9 月至 2021 年 3 月期间在 CIBERESUCICOVID 数据库中登记的 3 家国家医院的重症监护病房收治的年龄在 18 岁及以上的 482 名被诊断为 SARS-CoV-2 肺炎的患者进行了一项观察性研究。在确定样本特征后，分析了危险因素，构建了预测模型，并计算了每个因素的粗比值。此外，还使用逻辑回归建立了调整潜在混杂因素的多变量模型。最终模型仅包括使用后向法选择的变量。共获得 335 名男性（69.5%）和 145 名女性（30.08%）的样本，年龄为 61.94±12.75 岁，体重指数（BMI）为 28.05（25.7；31.2）。共有 113 名患者接受了无创机械通气。最常见的合并症为：高血压（51.04%）、肥胖症（28%）、糖尿病（23.44%）、其他代谢性疾病（21.16%）、慢性心力衰竭（18.05%）、慢性阻塞性肺疾病（11.62%）和慢性肾脏病（10.16%）。BMI＞30（n=135）与 BMI≤30（n=347）的患者住院、3 个月和 6 个月出院后死亡率有显著差异（P=.06）。BMI＞30 的患者中，有 42.4%的患者无创机械通气失败，而 BMI≤30 的患者中，有 55%的患者无创机械通气失败。本研究确定了与机械通气失败相关的因素。最常见的合并症为充血性心力衰竭、高血压、慢性肾脏病、严重肝脏疾病、糖尿病和实体器官移植。在通气支持方面，入院时接受高流量鼻氧疗的患者死亡率较低。肾脏替代治疗的使用也与死亡率升高显著相关。
