Lee Dahae, Lee Jung Ho, Jung Eujene, Cho Yong Soo, Ryu Hyun Ho
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61468, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61468, Republic of Korea.
Medicina (Kaunas). 2024 Dec 21;60(12):2095. doi: 10.3390/medicina60122095.
: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. : Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. : During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11-1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24-1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2-1.5). : Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions.
院外心脏骤停（OHCA）患者出现发热与不良临床结局相关，因为发热会加重神经损伤、增加代谢需求并引发炎症反应。本研究评估了新冠疫情及相关发热对OHCA结局的影响，并探讨其如何恶化患者预后。：我们的回顾性观察分析使用了来自国家急诊科信息系统（NEDIS）的数据，该数据包括2020年1月27日至12月31日（新冠疫情期间）韩国402家急诊科的成年OHCA患者以及2019年同期（新冠疫情前）的数据。主要结局是院内死亡率，以新冠疫情爆发作为主要暴露变量，发热作为重要的交互变量。我们采用带有交互项（就诊年份×发热）的多水平多变量逻辑回归来检验新冠疫情和发热对死亡率的影响。计算了风险调整后的死亡率，并通过差异分析评估了新冠疫情对不同发热状态下超额死亡率的影响。：在新冠疫情期间，OHCA患者的院内死亡率高于疫情前时期（调整后的比值比为1.22，95%置信区间为1.11 - 1.34），尤其是发热患者（调整后的比值比为1.40，95%置信区间为1.24 - 1.59）。交互分析显示，与非发热患者相比，新冠疫情使发热的OHCA患者死亡率增加得更多（差异：0.8%，95%置信区间为0.2 - 1.5）。：我们的研究发现，新冠疫情显著增加了OHCA患者的死亡率，发热患者由于系统性延误和疫情相关干扰而预后更差。
