患有和未患有新型冠状病毒肺炎的脓毒症危重症患者的长期特征和预后
Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19.
作者信息
Niebhagen Felix, Heubner Lars, Kirsch Anna, Güldner Andreas, Held Hanns-Christoph, Schneider Ralph, Bodechtel Ulf, Mehrholz Jan, Koch Thea, Menk Mario, Spieth Peter
机构信息
Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany.
Department of General Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany.
出版信息
J Crit Care. 2025 Feb;85:154942. doi: 10.1016/j.jcrc.2024.154942. Epub 2024 Oct 31.
BACKGROUND
In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.
METHODS
Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6-12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.
RESULTS
372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73-4.27; p < 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48-4.33; p < 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16-0.79) vs. 0.79 (0.69-0.99); p < 0.05).
CONCLUSIONS
In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.
背景
新冠肺炎脓毒症重症患者的院内死亡率显著高于非新冠肺炎患者。关于长期预后的了解仍然很少。在这项回顾性分析中，我们比较了合并或未合并新冠肺炎的脓毒症重症患者的临床特征、长期功能预后和生存率。
方法
收集2020年至2023年德累斯顿-克赖沙综合脓毒症中心登记处的非新冠肺炎脓毒症重症患者的数据。同期收集当地急性呼吸窘迫综合征/新冠肺炎登记处的新冠肺炎脓毒症重症患者的数据。脓毒症的诊断基于脓毒症-3定义。分析收集的变量来自电子健康记录。脓毒症诊断后6至12个月进行长期随访。使用Kaplan-Meier曲线描述生存率。通过Cox回归对长期死亡率与危险因素之间的关联进行建模。
结果
纳入了372例非新冠肺炎脓毒症患者和301例新冠肺炎脓毒症患者。合并新冠肺炎的脓毒症患者明显更年轻，Charlson合并症指数显著更低，入住重症监护病房时序贯器官衰竭评估（SOFA）评分显著更高。长期随访显示，合并新冠肺炎的脓毒症患者死亡率显著更高（73.4%对30.1%；风险比3.4（95%置信区间2.73 - 4.27；p < 0.05））。新冠肺炎感染与死亡率显著增加（调整后风险比3.27；95%置信区间2.48 - 4.33；p < 0.05）以及健康相关生活质量降低相关，以EQ - 5D - 3L指数衡量（0.56（0.16 - 0.79）对0.79（0.69 - 0.99）；p < 0.05）。
结论
在我们的脓毒症重症患者队列中，合并新冠肺炎的患者健康相关生活质量和长期生存率显著降低。此外，新冠肺炎可被确定为这些患者长期死亡率较高的独立危险因素。
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