Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador.
Servicio de Emergencias, Hospital Pablo Arturo Suárez, Quito, Ecuador.
Medicine (Baltimore). 2024 Jul 26;103(30):e38776. doi: 10.1097/MD.0000000000038776.
Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.
在重症监护病房（ICU）中，COVID-19 感染患者的死亡率与几个风险因素相关。我们评估了与人群特征和临床史、实验室检测结果、药物管理和通气类型相关的风险因素对 ICU 存活率/出院的影响。这是一项针对 2020 年 3 月至 2021 年 12 月期间入住 ICU 的 COVID-19 成年患者的回顾性队列多中心研究。数据来自厄瓜多尔 5 个城市的 6 家医院。主要结局是 ICU 存活率/出院率。采用半参数 Cox 比例风险模型进行生存分析。在入住 ICU 的 COVID-19 患者中（n=991），平均年龄为 56.76±13.14 岁，65.9%为男性。关于主要结局，51.1%（n=506）死亡，48.9%（n=485）存活。在死亡组中，他们的平均年龄高于幸存者（分别为 60.7 岁和 52.60 岁），且更常见合并症，如动脉高血压（分别为 37.2%和 20.4%）和糖尿病（分别为 26.9%和 15.7%），P<.001。在通气管理方面，32.7%的患者使用无创通气和高流量鼻导管，67.3%需要有创通气支持。调整混杂因素后，Cox 回归分析显示，如果患者符合以下条件，其 ICU 存活出院的可能性较小：动脉高血压（危险比[HR]=0.83 95%置信区间 0.723-0.964）、糖尿病（HR=0.80 95% CI 0.696-0.938）、年龄大于 62 岁（HR=0.86 95% CI 0.790-0.956）、肥胖（BMI≥30）（HR=0.78 95% CI 0.697-0.887）、SOFA 评分增加 1 分（HR=0.94 95% CI 0.937-0.961）、PaO2/FiO2 比值<100mmHg（HR=0.84 95% CI 0.786-0.914）和使用有创机械通气（HR=0.68 95% CI 0.614-0.769）。与死亡率增加相关的风险因素包括年龄较大、肥胖、动脉高血压和糖尿病。在我们的研究中，其他研究报道的性别、慢性阻塞性肺疾病、急性肾损伤和癌症等因素对死亡率没有相同的影响。
