Inpatient COVID-19 mortality has reduced over time: Results from an observational cohort.
Inpatient COVID-19 mortality has reduced over time: Results from an observational cohort.
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DOI：
10.1371/journal.pone.0261142
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Norton S
中科院分区：
文献类型：
--
作者：
Bechman K;Yates M;Mann K;Nagra D;Smith LJ;Rutherford AI;Patel A;Periselneris J;Walder D;Dobson RJB;Kraljevic Z;Teo JHT;Bernal W;Barker R;Galloway JB;Norton S
2019冠状病毒病疫情在英国经历了两波;第一波始于2020年3月，第二波始于2020年10月下旬。目前尚不清楚第一波和第二波严重新冠肺炎患者的结果是否不同。研究人群包括2020年3月至2021年3月期间在一家拥有1,500张床位的伦敦医院信托基金会住院的所有患者，这些患者在入院后3天内通过PCR检测新冠肺炎呈阳性。主要结局为入院后28天内死亡。纳入社会人口统计学（年龄、性别、种族）、高血压、糖尿病、肥胖、基线生理学观察结果、CRP、中性粒细胞、胸部X线异常、Remdesivir和地塞米松作为协变量。比例子危险模型比较了第1波和第2波之间的死亡风险。采用Cox比例风险模型和倾向评分调整来比较接受Remdesivir和地塞米松治疗的患者的死亡率。有3，949人因新冠肺炎入院，3，195人出院，733人死亡。第1波和第2波之间在年龄、种族、合并症和入院疾病严重程度方面存在显著差异。第1波期间的28天死亡率较高（26.1% vs 13.1%）。与第1波相比，第2波中校正协变量的死亡风险显著降低[adjSHR 0.49（0.37，0.65）p<0.001]。对治疗影响的分析未显示Remdesivir [HR 0.84（95%CI 0.65，1.08），p = 0.17]或地塞米松[HR 0.97（95%CI 0.70，1.35）p = 0.87]的统计学差异。即使考虑到人口统计学、合并症和疾病严重程度，第二波COVID-19死亡率也有了大幅改善。地塞米松和瑞德西韦似乎都不是关键的解释因素，尽管可能存在不可测量的混杂因素。
The Covid-19 pandemic in the United Kingdom has seen two waves; the first starting in March 2020 and the second in late October 2020. It is not known whether outcomes for those admitted with severe Covid were different in the first and second waves. The study population comprised all patients admitted to a 1,500-bed London Hospital Trust between March 2020 and March 2021, who tested positive for Covid-19 by PCR within 3-days of admissions. Primary outcome was death within 28-days of admission. Socio-demographics (age, sex, ethnicity), hypertension, diabetes, obesity, baseline physiological observations, CRP, neutrophil, chest x-ray abnormality, remdesivir and dexamethasone were incorporated as co-variates. Proportional subhazards models compared mortality risk between wave 1 and wave 2. Cox-proportional hazard model with propensity score adjustment were used to compare mortality in patients prescribed remdesivir and dexamethasone. There were 3,949 COVID-19 admissions, 3,195 hospital discharges and 733 deaths. There were notable differences in age, ethnicity, comorbidities, and admission disease severity between wave 1 and wave 2. Twenty-eight-day mortality was higher during wave 1 (26.1% versus 13.1%). Mortality risk adjusted for co-variates was significantly lower in wave 2 compared to wave 1 [adjSHR 0.49 (0.37, 0.65) p<0.001]. Analysis of treatment impact did not show statistically different effects of remdesivir [HR 0.84 (95%CI 0.65, 1.08), p = 0.17] or dexamethasone [HR 0.97 (95%CI 0.70, 1.35) p = 0.87]. There has been substantial improvements in COVID-19 mortality in the second wave, even accounting for demographics, comorbidity, and disease severity. Neither dexamethasone nor remdesivir appeared to be key explanatory factors, although there may be unmeasured confounding present.
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DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
COVID-19 国家早期预警评分 (NEWS2) 的评估和改进：一项多医院研究
影响因子：
9.3
作者：
Carr E;Bendayan R;Bean D;Stammers M;Wang W;Zhang H;Searle T;Kraljevic Z;Shek A;Phan HTT;Muruet W;Gupta RK;Shinton AJ;Wyatt M;Shi T;Zhang X;Pickles A;Stahl D;Zakeri R;Noursadeghi M;O'Gallagher K;Rogers M;Folarin A;Karwath A;Wickstrøm KE;Köhn-Luque A;Slater L;Cardoso VR;Bourdeaux C;Holten AR;Ball S;McWilliams C;Roguski L;Borca F;Batchelor J;Amundsen EK;Wu X;Gkoutos GV;Sun J;Pinto A;Guthrie B;Breen C;Douiri A;Wu H;Curcin V;Teo JT;Shah AM;Dobson RJB
通讯作者：
Dobson RJB
影响因子：
28.2
作者：
Galloway, James B.;Norton, Sam;Cantle, Fleur
通讯作者：
Cantle, Fleur
影响因子：
158.5
作者：
Beigel, John H.;Tomashek, Kay M.;Lane, H. Clifford
通讯作者：
Lane, H. Clifford
影响因子：
15.1
作者：
Zakeri R;Bendayan R;Ashworth M;Bean DM;Dodhia H;Durbaba S;O'Gallagher K;Palmer C;Curcin V;Aitken E;Bernal W;Barker RD;Norton S;Gulliford M;Teo JTH;Galloway J;Dobson RJB;Shah AM
通讯作者：
Shah AM