Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States
Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States
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DOI：
10.7326/m20-5327
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发表时间：
2021-05-01
影响因子：
39.2
通讯作者：
Gutsche, Jacob T.
中科院分区：
文献类型：
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作者：
Anesi, George L.;Jablonski, Juliane;Gutsche, Jacob T.
背景资料：2019冠状病毒病（COVID-19）大流行继续在美国和全球范围内激增。目的：描述COVID-19相关危重疾病的流行病学，包括结局和护理提供的趋势。设计：单一卫生系统，多医院回顾性队列研究。设置：宾夕法尼亚大学卫生系统内的5家医院。患者：在大流行初期因急性呼吸衰竭或休克而入住重症监护室（ICU）的COVID-19相关重症患者。测量：结果和护理提供趋势分析的主要暴露是大流行期间的纵向时间。主要结局为28天住院期间全因死亡率。结果：在468例COVID-19相关危重病患者中，319例（68.2%）接受了机械通气治疗，121例（25.9%）接受了血管加压药治疗。结果值得注意的是，全因28天住院死亡率为29.9%，中位ICU住院时间为8天（四分位距[IQR]，3至17天），中位住院时间为13天（IQR，7至25天），全因30天再入院率（非临终关怀幸存者）为10.8%。死亡率随着时间的推移从43.5%（95% CI，31.3%至53.8%）至19.2%在核心校正模型中，第一个和最后15天之间的CI为11.6%至26.7%，而患者的紧急程度和其他因素没有变化。没有评估其他临床干预措施的使用或高度动态趋势，也没有评估并发症。在美国一个学习卫生系统的ICU收治的COVID-19相关重症患者中，尽管患者特征稳定，但死亡率似乎随时间降低。进一步的研究是必要的，以确认这一结果，并调查因果机制。
Background: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally.Objective: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery.Design: Single-health system, multihospital retrospective cohort study.Setting: 5 hospitals within the University of Pennsylvania Health System.Patients: Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic.Measurements: The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions.Results: Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change.Limitations: Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications.Conclusion: Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms.