Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis.
Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis.
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DOI：
10.1164/rccm.202006-2405oc
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发表时间：
2021-01-01
影响因子：
24.7
通讯作者：
Rubulotta F
中科院分区：
文献类型：
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作者：
Lim ZJ;Subramaniam A;Ponnapa Reddy M;Blecher G;Kadam U;Afroz A;Billah B;Ashwin S;Kubicki M;Bilotta F;Curtis JR;Rubulotta F
理由：接受有创机械通气 (IMV) 的冠状病毒病 (COVID-19) 成人患者病死率 (CFR) 的初步报告差异很大。目的：检查接受 IMV 的 COVID-19 患者的病死率 (CFR)。方法：两位作者独立检索了 PubMed、Embase、medRxiv、bioRxiv、COVID-19 生活系统评价和国家注册数据库。主要结局是确诊需要 IMV 的 COVID-19 患者的“报告的 CFR”。还对出院时患者的“最终医院病死率”进行了调查。最后，根据纽卡斯尔-渥太华量表，根据患者年龄、地理区域和研究质量对 CFR 进行分析。测量和结果：纳入了 69 项研究，描述了 57,420 名接受 IMV 的 COVID-19 成年患者。总体报告的 CFR 估计为 45%（95% 置信区间 [CI]，39-52%）。 69 项研究中的 54 项说明了医院结果是否可用，但仅对 IMV 患者总数中的 13,120 名 (22.8%) 提供了明确的医院结果。在可获得年龄分层 CFR 的研究中，年轻患者（年龄≤40 岁）的汇总 CFR 估计值为 47.9%（95% CI，46.4–49.4%），老年患者（年龄 >80 岁）为 84.4%（95% CI，83.3–85.4%）。 COVID-19 早期震中的病死率也较高。总体异质性较高（I2 >90%），Egger 回归测试不显着，表明不存在发表偏倚。结论：根据报告的 CFR，几乎一半接受 IMV 的 COVID-19 患者死亡，但不同的 CFR 报告方法导致研究之间的 CFR 存在较大差异。报告的病死率在老年患者和早期大流行震中较高，这可能受到 ICU 资源有限的影响。报告所有患者的明确结果将有助于研究之间的比较。在 PROSPERO 注册的系统审查 (CRD42020186997)。
Rationale: Initial reports of case fatality rates (CFRs) among adults with coronavirus disease (COVID-19) receiving invasive mechanical ventilation (IMV) are highly variable. Objectives: To examine the CFR of patients with COVID-19 receiving IMV. Methods: Two authors independently searched PubMed, Embase, medRxiv, bioRxiv, the COVID-19 living systematic review, and national registry databases. The primary outcome was the “reported CFR” for patients with confirmed COVID-19 requiring IMV. “Definitive hospital CFR” for patients with outcomes at hospital discharge was also investigated. Finally, CFR was analyzed by patient age, geographic region, and study quality on the basis of the Newcastle-Ottawa Scale. Measurements and Results: Sixty-nine studies were included, describing 57,420 adult patients with COVID-19 who received IMV. Overall reported CFR was estimated as 45% (95% confidence interval [CI], 39–52%). Fifty-four of 69 studies stated whether hospital outcomes were available but provided a definitive hospital outcome on only 13,120 (22.8%) of the total IMV patient population. Among studies in which age-stratified CFR was available, pooled CFR estimates ranged from 47.9% (95% CI, 46.4–49.4%) in younger patients (age ≤40 yr) to 84.4% (95% CI, 83.3–85.4%) in older patients (age >80 yr). CFR was also higher in early COVID-19 epicenters. Overall heterogeneity is high (I2 >90%), with nonsignificant Egger’s regression test suggesting no publication bias. Conclusions: Almost half of patients with COVID-19 receiving IMV died based on the reported CFR, but variable CFR reporting methods resulted in a wide range of CFRs between studies. The reported CFR was higher in older patients and in early pandemic epicenters, which may be influenced by limited ICU resources. Reporting of definitive outcomes on all patients would facilitate comparisons between studies. Systematic review registered with PROSPERO (CRD42020186997).