Sadana Divyajot, Granton David, Adhikari Neill K J, Pinto Ruxandra, Murthy Srinivas, Fowler Robert A
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Can J Anaesth. 2024 Dec;71(12):1745-1754. doi: 10.1007/s12630-024-02826-x. Epub 2024 Sep 4.
Our objective was to investigate the temporal trends in baseline characteristics, interventions, and clinical outcomes in patients hospitalized with COVID-19 in Canada over five pandemic waves.
We conducted a multicentre prospective cohort study enrolling adults and children admitted with COVID-19 from 47 Canadian hospitals. We compared characteristics, interventions, and outcomes of patients across five distinct pandemic waves.
We enrolled 5,285 patients between 2 January 2020 and 8 February 2022. The mean (standard deviation) age was 62.6 (21.0) yr; 41.2% (n = 2,176) were female, and 48% (n = 2,539) required admission to an intensive care unit (ICU), of whom 60.3% (n = 1,530) underwent invasive mechanical ventilation. The proportion of vaccinated patients increased over time. The proportion of vaccinated hospitalized patients progressing to require ICU admission fell over pandemic waves while the proportion of unvaccinated hospitalized patients progressing to require ICU admission did not. Patients were most commonly treated with corticosteroids (48.7%; n = 2,575); use of corticosteroids and other evidence-based treatments increased over time. Hospital mortality was 22.1% (n = 1,166) among all patients, 30.2% (n = 766) among those admitted to an ICU, and 37.9% (n = 580) among those requiring invasive mechanical ventilation. Younger age, absence of chronic cardiac or pulmonary disease, severity of illness at admission, and prior vaccination was associated with a lower mortality; however, pandemic wave itself was not.
Among patients hospitalized in Canada with COVID-19, several clinical factors including prior vaccination were associated with lower mortality, but pandemic wave was not.
我们的目标是调查在加拿大五波疫情期间，新冠肺炎住院患者的基线特征、治疗措施及临床结局随时间的变化趋势。
我们开展了一项多中心前瞻性队列研究，纳入了来自加拿大47家医院的新冠肺炎成年及儿童住院患者。我们比较了五波不同疫情期间患者的特征、治疗措施及结局。
在2020年1月2日至2022年2月8日期间，我们共纳入了5285例患者。平均（标准差）年龄为62.6（21.0）岁；41.2%（n = 2176）为女性，48%（n = 2539）需要入住重症监护病房（ICU），其中60.3%（n = 1530）接受了有创机械通气。接种疫苗的患者比例随时间增加。在各波疫情期间，接种疫苗的住院患者进展至需要入住ICU的比例下降，而未接种疫苗的住院患者进展至需要入住ICU的比例未下降。患者最常接受的治疗是使用皮质类固醇（48.7%；n = 2575）；皮质类固醇及其他循证治疗的使用随时间增加。所有患者的医院死亡率为22.1%（n = 1166），入住ICU的患者为30.2%（n = 766），需要有创机械通气的患者为37.9%（n = 580）。年龄较小、无慢性心脏或肺部疾病、入院时疾病严重程度及既往接种疫苗与较低死亡率相关；然而，疫情波次本身与死亡率无关。
在加拿大新冠肺炎住院患者中，包括既往接种疫苗在内的几个临床因素与较低死亡率相关，但疫情波次与死亡率无关。
