Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study
Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study
复制标题
DOI：
10.1016/s0140-6736(20)31189-2
复制
发表时间：
2020-06-06
期刊：
影响因子：
168.9
通讯作者：
O'Donnell, Max R.
中科院分区：
文献类型：
--
作者：
Cummings, Matthew J.;Baldwin, Matthew R.;O'Donnell, Max R.
背景截至2020年4月28日，纽约市（美国纽约州）已有超过40，000名COVID-19患者住院。方法这项前瞻性观察性队列研究在北方曼哈顿的哥伦比亚大学欧文医学中心附属的两家纽约长老会医院进行。我们前瞻性地确定了2020年3月2日至4月1日期间在两家医院住院的成年患者（年龄≥ 18岁），这些患者被诊断患有实验室确诊的COVID-19，并患有急性低氧性呼吸衰竭的危重病，并收集了临床、生物标志物和治疗数据。主要结局是院内死亡率。次要结局包括有创机械通气的频率和持续时间、血管加压药使用和肾脏替代治疗的频率以及入院后至住院临床恶化的时间。使用考克斯比例风险回归对临床危险因素、生物标志物和住院死亡率之间的关系进行建模。结果2020年3月2日至4月1日期间，两家医院共收治了1150名实验室确诊的COVID-19成人患者，其中257人（22%）病情危重。患者的中位年龄为62岁（IQR 51-72），171例（67%）为男性。212例（82%）患者至少患有一种慢性疾病，其中最常见的是高血压（162例[63%]）和糖尿病（92例[36%]）。119例（46%）患者患有肥胖症。截至2020年4月28日，101名（39%）患者死亡，94名（37%）患者仍在住院治疗。203例（79%）患者接受有创机械通气，中位时间为18天（IQR 9-28），257例患者中有170例（66%）接受血管加压药，79例（31%）接受肾脏替代治疗。至院内恶化的中位时间为3天（IQR 1-6）。在多变量考克斯模型中，（校正风险比[aHR] 1.31 [1.09-1.57]/10年增加），慢性心脏病（aHR 1.76 [1.08-2.86]），慢性肺病（aHR 2.94 [1.48-5.84]），较高浓度的白细胞介素-6（每增加十分位数aHR 1.11 [95%CI 1.02-1.20]），D-二聚体的浓度更高（每增加十分位数aHR 1.10 [1.01-1.19]）与住院死亡率独立相关。19在纽约市是常见的，并与高频率的有创机械通气、肺外器官功能障碍和大量的院内死亡率相关。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.Methods This prospective observational cohort study took place at two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in northern Manhattan. We prospectively identified adult patients (aged >= 18 years) admitted to both hospitals from March 2 to April 1, 2020, who were diagnosed with laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was the rate of in-hospital death. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal replacement therapy, and time to in-hospital clinical deterioration following admission. The relation between clinical risk factors, biomarkers, and in-hospital mortality was modelled using Cox proportional hazards regression. Follow-up time was right-censored on April 28, 2020 so that each patient had at least 28 days of observation.Findings Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill. The median age of patients was 62 years (IQR 51-72), 171 (67%) were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (162 [63%]) and diabetes (92 [36%]). 119 (46%) patients had obesity. As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised. 203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9-28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy. The median time to in-hospital deterioration was 3 days (IQR 1-6). In the multivariable Cox model, older age (adjusted hazard ratio [aHR] 1.31 [1.09-1.57] per 10-year increase), chronic cardiac disease (aHR 1.76 [1.08-2.86]), chronic pulmonary disease (aHR 2.94 [1.48-5.84]), higher concentrations of interleukin-6 (aHR 1.11 [95%CI 1.02-1.20] per decile increase), and higher concentrations of D-dimer (aHR 1.10 [1.01-1.19] per decile increase) were independently associated with in-hospital mortality.Interpretation Critical illness among patients hospitalised with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality. Copyright (C) 2020 Elsevier Ltd. All rights reserved.