Joint analysis of duration of ventilation, length of intensive care, and mortality of COVID-19 patients: a multistate approach.
Joint analysis of duration of ventilation, length of intensive care, and mortality of COVID-19 patients: a multistate approach.
复制标题
DOI：
10.1186/s12874-020-01082-z
复制
发表时间：
2020-08-11
影响因子：
4
通讯作者：
Wolkewitz M
中科院分区：
文献类型：
--
作者：
Hazard D;Kaier K;von Cube M;Grodd M;Bugiera L;Lambert J;Wolkewitz M
因新冠肺炎入院的患者的临床进展通常与严重肺炎相关，这可能需要重症监护、有创呼吸机或体外膜肺氧合。重症监护的持续时间和这些支持性治疗的持续时间是临床相关的结果。从统计的角度来看，这些数量很难估计，因为事件是时间相关的，可能是多个事件，以及由相互竞争的最终事件--出院和死亡--决定的。我们使用多状态模型来研究新冠肺炎患者的时间依赖性进展，并提供了一个统计框架来估计危险率和转移概率。这些估计值可用于量化重症监护和有创呼吸机等临床重要状态的平均逗留时间。我们已经公开了两个真实的新冠肺炎患者数据集(n = 24*和n = 53**)和相应的统计代码。两组患者在重症监护病房(ICU)第28天的预期住院时间分别为15.05天和19.62天，而预期的机械通气时间分别为7.97天和9.85天。预计死亡率为51%*和15%**。与28 天后未机械通气的患者(4.34*，1.41**天)相比，在范例研究开始时机械通气的患者的预期机械通气持续时间(12.25*，14.57**天)更长。此外，最初使用呼吸机的患者在4个 周后死亡风险更高(54%*和20%*对48%*和6%**)。这些结果在从时间零开始的两组以及整个队列的堆叠概率图中进一步说明，该队列描绘了在每个状态下的患者在随访期间的预测比例。多状态方法为新冠肺炎患者在机械通气时间、重症监护病房停留时间和死亡率方面的进展提供了重要的见解。除了避免生存分析中的频繁陷阱外，该方法还允许通过审查来分析活动病例。堆叠的概率图以简明的方式提供了广泛的信息，可以很容易地传达给有关医疗保健能力的决策者。此外，还可以在不同的基线特征之间进行明确的比较。
The clinical progress of patients hospitalized due to COVID-19 is often associated with severe pneumonia which may require intensive care, invasive ventilation, or extracorporeal membrane oxygenation (ECMO). The length of intensive care and the duration of these supportive therapies are clinically relevant outcomes. From the statistical perspective, these quantities are challenging to estimate due to episodes being time-dependent and potentially multiple, as well as being determined by the competing, terminal events of discharge alive and death. We used multistate models to study COVID-19 patients’ time-dependent progress and provide a statistical framework to estimate hazard rates and transition probabilities. These estimates can then be used to quantify average sojourn times of clinically important states such as intensive care and invasive ventilation. We have made two real data sets of COVID-19 patients (n = 24* and n = 53**) and the corresponding statistical code publically available. The expected lengths of intensive care unit (ICU) stay at day 28 for the two cohorts were 15.05* and 19.62** days, while expected durations of mechanical ventilation were 7.97* and 9.85** days. Predicted mortality stood at 51%* and 15%**. Patients mechanically ventilated at the start of the example studies had a longer expected duration of ventilation (12.25*, 14.57** days) compared to patients non-ventilated (4.34*, 1.41** days) after 28 days. Furthermore, initially ventilated patients had a higher risk of death (54%* and 20%** vs. 48%* and 6%**) after 4 weeks. These results are further illustrated in stacked probability plots for the two groups from time zero, as well as for the entire cohort which depicts the predicted proportions of the patients in each state over follow-up. The multistate approach gives important insights into the progress of COVID-19 patients in terms of ventilation duration, length of ICU stay, and mortality. In addition to avoiding frequent pitfalls in survival analysis, the methodology enables active cases to be analyzed by allowing for censoring. The stacked probability plots provide extensive information in a concise manner that can be easily conveyed to decision makers regarding healthcare capacities. Furthermore, clear comparisons can be made among different baseline characteristics.
登录
查看更多内容
影响因子：
158.5
作者：
Grein, J.;Ohmagari, N.;Flanigan, T.
通讯作者：
Flanigan, T.
影响因子：
3.8
作者：
Lipsitch M;Donnelly CA;Fraser C;Blake IM;Cori A;Dorigatti I;Ferguson NM;Garske T;Mills HL;Riley S;Van Kerkhove MD;Hernán MA
通讯作者：
Hernán MA
影响因子：
7.2
作者：
van Walraven, C;Davis, D;Wells, GA
通讯作者：
Wells, GA
影响因子：
7.2
作者：
Beyersmann, Jan;Gastmeier, Petra;Schumacher, Martin
通讯作者：
Schumacher, Martin
影响因子：
7.2
作者：
Wolkewitz, Martin;Schumacher, Martin
通讯作者：
Schumacher, Martin