Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC.
St Vincent's Hospital, Melbourne, VIC.
Med J Aust. 2024 Aug 19;221(4):209-216. doi: 10.5694/mja2.52390. Epub 2024 Jul 17.
To compare in-hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022-23 with coronavirus disease 2019 (COVID-19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, or without SAR-CoV-2 infections.
Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data.
SETTING, PARTICIPANTS: Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 - 30 June 2023.
The primary outcome was in-hospital mortality, the secondary outcome ICU length of stay, each by SARS-CoV-2 infection attribution classification: primary COVID-19; exacerbating SARS-CoV-2 infection (SARS-CoV-2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS-CoV-2 infections (SARS-CoV-2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS-CoV-2 infection.
A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022-23; 2674 people (1.3%) had incidental SARS-CoV-2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID-19. Unadjusted in-hospital mortality for people with incidental SARS-CoV-2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID-19 (830 deaths, 22.9%), but higher than for patients without SARS-CoV-2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS-CoV-2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10-1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22-1.48), or primary COVID-19 (aOR, 2.54; 95% CI, 2.30-2.81) than for patients without SARS-CoV-2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4-4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2-1.5 hours) than for those without SARS-CoV-2 infections.
Risk-adjusted in-hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS-CoV-2 infections than for people who do not.
比较 2022-23 年澳大利亚和新西兰重症监护病房（ICU）因 2019 年冠状病毒病（COVID-19）肺炎、继发或加重严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染或无 SARS-CoV-2 感染而入住的患者的住院死亡率和 ICU 住院时间。
回顾性队列研究；对澳大利亚和新西兰重症监护学会（ANZICS）成人患者数据库数据进行分析。
地点、参与者：2022 年 1 月 1 日至 2023 年 6 月 30 日期间，在澳大利亚或新西兰参与 ICU 治疗的 16 岁或以上成年人。
主要结局指标为住院死亡率，次要结局指标为 ICU 住院时间，每个结局指标按 SARS-CoV-2 感染归因分类：原发性 COVID-19；继发 SARS-CoV-2 感染（SARS-CoV-2 感染是 ICU 入院主要原因的促成因素）；偶然 SARS-CoV-2 感染（在 ICU 住院期间检测到 SARS-CoV-2 感染，但未促成入院诊断）；无 SARS-CoV-2 感染。
在 2022-23 年期间，共有 207684 名成年人入住澳大利亚和新西兰的 195 家 ICU；2674 人（1.3%）有偶然 SARS-CoV-2 感染，4923 人（2.4%）有继发感染，3620 人（1.7%）有原发性 COVID-19。偶然 SARS-CoV-2 感染患者（288 例死亡，10.8%）的未调整住院死亡率低于继发感染患者（928 例死亡，18.8%）或原发性 COVID-19 患者（830 例死亡，22.9%），但高于无 SARS-CoV-2 感染患者（15486 例死亡，7.9%）。在调整疾病严重程度、脆弱性、地理位置和医院类型后，偶然 SARS-CoV-2 感染患者（调整后的优势比[aOR]，1.28；95%置信区间[CI]，1.10-1.50）、继发感染患者（aOR，1.35；95% CI，1.22-1.48）或原发性 COVID-19 患者（aOR，2.54；95% CI，2.30-2.81）的死亡率均高于无 SARS-CoV-2 感染患者。在调整诊断和疾病严重程度后，偶然感染（平均差异，3.3 小时；95%CI，2.4-4.2 小时）或继发感染（0.8 小时；95%CI，0.2-1.5 小时）患者的 ICU 住院时间长于无 SARS-CoV-2 感染患者。
与未感染 SARS-CoV-2 的患者相比，同时感染 SARS-CoV-2 的重症监护患者的住院死亡率和 ICU 住院时间的风险调整后更高。
