de Andrade Camila Rabelo Monteiro, Luz Fernanda Silva Trindade, de Oliveira Neimy Ramos, Kopittke Luciane, Santa Rosa Luiza Marinho Motta, Gomes Angelica Gomides Dos Reis, Bartolazzi Frederico, Francisco Saionara Cristina, da Costa Felicio Roberto, Jorge Alzira de Oliveira, Cimini Christiane Corrêa Rodrigues, Carneiro Marcelo, Ruschel Karen Brasil, Schwarzbold Alexandre Vargas, Ponce Daniela, Ferreira Maria Angélica Pires, Guimarães Júnior Milton Henriques, Silveira Daniel Vitório, Aranha Fernando Graça, de Carvalho Rafael Lima Rodrigues, de Godoy Mariana Frizzo, Viana Lucas Macedo Pereira, Hirakata Vânia Naomi, Bicalho Maria Aparecida Camargos, Marcolino Milena Soriano
Centro Universitário de Belo Horizonte, UniBH. Av. Professor Mário Werneck, Belo Horizonte, Brazil.
Hospital Metropolitano Odilon Behrens. R. Formiga, Belo Horizonte, Brazil.
Front Med (Lausanne). 2024 Jul 25;11:1390057. doi: 10.3389/fmed.2024.1390057. eCollection 2024.
COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.
To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.
This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).
Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves.
A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.
新冠病毒病在身体、心理和社会领域引发了复杂的痛苦，而姑息治疗有潜力显著减轻这种痛苦。
描述有姑息治疗指征的新冠病毒病患者与无此指征患者在不同疫情波中的临床特征和结局。
这项回顾性多中心观察性队列研究纳入了2020年3月至2022年8月期间40家医院收治的患者。病历中有姑息治疗指征描述的患者被纳入姑息治疗组（PCG），而病历中无此指征的患者被分配到非姑息治疗组（NPCG）。
在21158例患者中，只有6.7%的患者病历中有姑息治疗指征记录。与NPCG相比，PCG患者年龄更大，合并症发生率更高，虚弱程度更高，临床并发症和死亡率的患病率也更高（81.4%对17.7%，<0.001）。在人工生命支持方面，PCG患者接受透析的频率更高（20.4%对10.1%，p<0.001），有创机械通气的频率更高（48.2%对26.0%，p<0.001），入住重症监护病房的频率更高（53.6%对35.4%，p<0.001）。所有三个疫情波中的这些差异都是一致的。
接受姑息治疗的患者比例较低。PCG患者更脆弱，临床并发症更多，死亡率更高。与我们的预期相反，他们在所有三个疫情波中接受的人工生命支持更多。综上所述，这些发现表明，在临终和治疗失败的背景下，关于姑息治疗指征的决策做出得太晚了。
