Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020.
Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020.
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DOI：
10.1097/ccm.0000000000004747
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发表时间：
2021-02-01
影响因子：
8.8
通讯作者：
Mateen BA
中科院分区：
文献类型：
--
作者：
Dennis JM;McGovern AP;Vollmer SJ;Mateen BA
补充数字内容可在文本中找到。测量2019年需要重症监护（高依赖病房或ICU）管理的严重冠状病毒病患者随时间推移的生存率时间趋势，并评估死亡率的时间变化是否可以通过患者人口统计学和合并症负担随时间推移的变化来解释。回顾性观察队列;基于向英格兰COVID-19住院监测系统报告的数据。主要结局为住院30天全因死亡率。未校正的生存期按入院时的日历周估计，考克斯比例风险模型用于估计校正的生存期，控制年龄、性别、种族、主要合并症和地理区域。108个英国重症监护室。2020年3月1日至2020年6月27日期间所有成人（18岁以上）冠状病毒病2019特定重症监护入院。不适用因纳入了21，820例重症监护患者（高依赖性病房n = 15，367; ICU n = 5，715）。3月下旬在高依赖单位（71.6%生存率）和ICU（58.0%生存率）住院的患者的30天未调整生存率最低。到6月底，高依赖病房的存活率提高到92.7%，ICU的存活率提高到80.4%。在调整患者特征（年龄、性别、种族和主要合并症）和地理区域后，生存率仍有改善。在英格兰，2019年冠状病毒病重症监护患者的生存率大幅提高，5月和6月入院的患者的生存率明显高于3月和4月入院的患者。我们的分析表明，这种改善不是由于年龄、性别、种族或住院患者的主要合并症负担的时间变化。
Supplemental Digital Content is available in the text. To measure temporal trends in survival over time in people with severe coronavirus disease 2019 requiring critical care (high dependency unit or ICU) management, and to assess whether temporal variation in mortality was explained by changes in patient demographics and comorbidity burden over time. Retrospective observational cohort; based on data reported to the COVID-19 Hospitalisation in England Surveillance System. The primary outcome was in-hospital 30-day all-cause mortality. Unadjusted survival was estimated by calendar week of admission, and Cox proportional hazards models were used to estimate adjusted survival, controlling for age, sex, ethnicity, major comorbidities, and geographical region. One hundred eight English critical care units. All adult (18 yr +) coronavirus disease 2019 specific critical care admissions between March 1, 2020, and June 27, 2020. Not applicable. Twenty-one thousand eighty-two critical care patients (high dependency unit n = 15,367; ICU n = 5,715) were included. Unadjusted survival at 30 days was lowest for people admitted in late March in both high dependency unit (71.6% survival) and ICU (58.0% survival). By the end of June, survival had improved to 92.7% in high dependency unit and 80.4% in ICU. Improvements in survival remained after adjustment for patient characteristics (age, sex, ethnicity, and major comorbidities) and geographical region. There has been a substantial improvement in survival amongst people admitted to critical care with coronavirus disease 2019 in England, with markedly higher survival rates in people admitted in May and June compared with those admitted in March and April. Our analysis suggests this improvement is not due to temporal changes in the age, sex, ethnicity, or major comorbidity burden of admitted patients.