Outcomes Among Patients Hospitalized With Non-COVID-19 Conditions Before and During the COVID-19 Pandemic in Alberta and Ontario, Canada.
Outcomes Among Patients Hospitalized With Non-COVID-19 Conditions Before and During the COVID-19 Pandemic in Alberta and Ontario, Canada.
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在艾伯塔省和加拿大安大略省的COVID-19大流行之前和期间，患有非旋转19号病情的患者的结局。
DOI：
10.1001/jamanetworkopen.2023.23035
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发表时间：
2023-07-03
影响因子：
13.8
通讯作者：
Wijeysundera, Harindra C.
中科院分区：
文献类型：
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作者：
McAlister, Finlay A.;Chu, Anna;Qiu, Feng;Dong, Yuan;van Diepen, Sean;Youngson, Erik;Yu, Amy Y. X.;de Mestral, Charles;Ross, Heather J.;Austin, Peter C.;Lee, Douglas S.;Kadri, Sameer S.;Wijeysundera, Harindra C.
与大流行之前相比，大流行期间因非COVID-19疾病住院的患者，即使SARS-CoV-2检测结果为阴性，结果如何？在这项对132240名因常见疾病住院的患者进行的队列研究中，只有心力衰竭或慢性阻塞性肺病或哮喘患者在大流行期间显示出显著更高的风险调整后30天死亡率（分别高出16%和41%）。随着COVID-19病例量的增加，COVID-19患者的住院时间和风险调整后的死亡率显著增加，但非COVID-19患者的情况并非如此。研究结果显示，大多数因非COVID-19疾病（心力衰竭、慢性阻塞性肺病或哮喘除外）住院的患者在大流行期间（即使在COVID-19病例激增期间）显示出类似的风险调整后结果，表明面对医院占用压力的弹性。这项队列研究确定了在大流行之前和期间因非COVID-19疾病住院的患者的30天死亡率和住院时间是否不同。COVID-19住院病例数与因非COVID-19疾病住院患者的结局之间的关联尚不清楚。确定因非COVID-19疾病住院的患者的30天死亡率和住院时间（LOS）是否存在差异（1）在大流行之前和期间，以及（2）在COVID-19病例中。这项回顾性队列研究比较了2018年4月1日至2019年9月30日（大流行前）与2020年4月1日至2021年9月30日（大流行期间）在加拿大阿尔伯塔和安大略的235家急性护理医院的患者住院情况。纳入所有因心力衰竭（HF）、慢性阻塞性肺疾病（COPD）或哮喘、尿路感染或尿脓毒症、急性冠状动脉综合征或卒中住院的成人。每间医院于2020年4月至2021年9月的每月激增指数用作衡量COVID-19病例量相对于基线床位容量的指标。主要研究结局是通过分层多变量回归模型测量的5种选定疾病或COVID-19入院后30天全因死亡率。住院时间是次要结局。2018年4月至2019年9月，132240名患者（平均[SD]年龄，71.8 [14.8]岁; 61 493名女性[46.5%]和70 747名男性[53.5%]）因选定的医疗状况住院，这是他们最负责任的诊断，（平均[SD]年龄，71.9 [14.7]岁，52 058名女性[45.2%]和63 167名男性[54.8%]）（其中114 414人[99.3%]的SARS-CoV-2检测结果为阴性）。在大流行期间，患有任何选定疾病并伴随SARS-CoV-2感染的患者的LOS要长得多（平均值[SD]，8.6 [7.1]天或中位值延长6天[范围，1-22天]）和死亡率更高（不同诊断之间存在差异，但30天时平均[SD]绝对增加4.7% [3.1%]）。在大流行期间，因任何选定疾病而住院且未伴随SARS-CoV-2感染的患者的LOS与大流行前相似，只有HF患者（校正比值比[AOR]，1.16; 95% CI，1.09-1.24）和COPD或哮喘（AOR，1.41; 95%CI，1.30-1.53）在大流行期间的风险调整后30天死亡率较高。由于医院经历了COVID-19的激增，选定条件的患者的LOS和风险调整死亡率保持稳定，但COVID-19患者的LOS和风险调整死亡率较高。一旦容量达到第99百分位数以上，患者的30天死亡率AOR为1.80（95%CI，1.24-2.61），而当激增指数低于第75百分位数时。这项队列研究发现，在COVID-19病例激增期间，只有住院的COVID-19患者的死亡率显著较高。然而，大多数非COVID-19条件和SARS-CoV-2检测结果阴性的住院患者（HF或COPD或哮喘患者除外）在大流行期间表现出与大流行前相似的风险调整结果，即使在COVID-19病例量激增期间也是如此，这表明在发生区域或医院特定占用压力时的弹性。
What were the outcomes of patients hospitalized with non–COVID-19 conditions, even with negative SARS-CoV-2 test results, during the pandemic vs before the pandemic? In this cohort study of 132 240 patients hospitalized with common medical conditions, only those with heart failure or with chronic obstructive pulmonary disease or asthma exhibited a significantly higher risk-adjusted 30-day mortality during the pandemic (16% and 41% higher, respectively). As COVID-19 caseloads increased, lengths of stay and risk-adjusted mortality were significantly higher for patients with COVID-19 but not for those with non–COVID-19 conditions. The findings show that most patients hospitalized with non–COVID-19 conditions (except heart failure or chronic obstructive pulmonary disease or asthma) exhibited similar risk-adjusted outcomes during the pandemic, even during COVID-19 caseload surges, suggesting resilience in the face of hospital occupancy strains. This cohort study determines whether 30-day mortality and length of stay differed in patients hospitalized for non–COVID-19 conditions before and during the pandemic. The association of inpatient COVID-19 caseloads with outcomes in patients hospitalized with non–COVID-19 conditions is unclear. To determine whether 30-day mortality and length of stay (LOS) for patients hospitalized with non–COVID-19 medical conditions differed (1) before and during the pandemic and (2) across COVID-19 caseloads. This retrospective cohort study compared patient hospitalizations between April 1, 2018, and September 30, 2019 (prepandemic), vs between April 1, 2020, and September 30, 2021 (during the pandemic), in 235 acute care hospitals in Alberta and Ontario, Canada. All adults hospitalized for heart failure (HF), chronic obstructive pulmonary disease (COPD) or asthma, urinary tract infection or urosepsis, acute coronary syndrome, or stroke were included. The monthly surge index for each hospital from April 2020 through September 2021 was used as a measure of COVID-19 caseload relative to baseline bed capacity. The primary study outcome was 30-day all-cause mortality after hospital admission for the 5 selected conditions or COVID-19 as measured by hierarchical multivariable regression models. Length of stay was the secondary outcome. Between April 2018 and September 2019, 132 240 patients (mean [SD] age, 71.8 [14.8] years; 61 493 female [46.5%] and 70 747 male [53.5%]) were hospitalized for the selected medical conditions as their most responsible diagnosis compared with 115 225 (mean [SD] age, 71.9 [14.7] years, 52 058 female [45.2%] and 63 167 male [54.8%]) between April 2020 and September 2021 (114 414 [99.3%] of whom had negative SARS-CoV-2 test results). Patients admitted during the pandemic with any of the selected conditions and concomitant SARS-CoV-2 infection exhibited a much longer LOS (mean [SD], 8.6 [7.1] days or a median of 6 days longer [range, 1-22 days]) and greater mortality (varying across diagnoses, but with a mean [SD] absolute increase at 30 days of 4.7% [3.1%]) than those without coinfection. Patients hospitalized with any of the selected conditions without concomitant SARS-CoV-2 infection had similar LOSs during the pandemic as before the pandemic, and only patients with HF (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.24) and COPD or asthma (AOR, 1.41; 95% CI, 1.30-1.53) had a higher risk-adjusted 30-day mortality during the pandemic. As hospitals experienced COVID-19 surges, LOS and risk-adjusted mortality remained stable for patients with the selected conditions but were higher in patients with COVID-19. Once capacity reached above the 99th percentile, patients’ 30-day mortality AOR was 1.80 (95% CI, 1.24-2.61) vs when the surge index was below the 75th percentile. This cohort study found that during surges in COVID-19 caseloads, mortality rates were significantly higher only for hospitalized patients with COVID-19. However, most patients hospitalized with non–COVID-19 conditions and negative SARS-CoV-2 test results (except those with HF or with COPD or asthma) exhibited similar risk-adjusted outcomes during the pandemic as before the pandemic, even during COVID-19 caseload surges, suggesting resiliency in the event of regional or hospital-specific occupancy strains.
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影响因子：
2.9
作者：
Wu G;D'Souza AG;Quan H;Southern DA;Youngson E;Williamson T;Eastwood C;Xu Y
通讯作者：
Xu Y
DOI：
10.1136/bmj.n1135
发表时间：
2021-05-24
期刊：
BMJ (Clinical research ed.)
影响因子：
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作者：
Bodilsen J;Nielsen PB;Søgaard M;Dalager-Pedersen M;Speiser LOZ;Yndigegn T;Nielsen H;Larsen TB;Skjøth F
通讯作者：
Skjøth F
影响因子：
5.4
作者：
Bottle, Alex;Faitna, Puji;Aylin, Paul P.
通讯作者：
Aylin, Paul P.
影响因子：
6.2
作者：
McAlister, Finlay A.;Parikh, Harsh;Lee, Douglas S.;Wijeysundera, Harindra C.
通讯作者：
Wijeysundera, Harindra C.
DOI：
10.1503/cmaj.220272
发表时间：
2022-05-16
期刊：
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
影响因子：
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作者：
通讯作者：
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