Comparison of Clinical Features and Outcomes in Critically Ill Patients Hospitalized with COVID-19 versus Influenza.
Comparison of Clinical Features and Outcomes in Critically Ill Patients Hospitalized with COVID-19 versus Influenza.
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DOI：
10.1513/annalsats.202007-805oc
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发表时间：
2021-04
影响因子：
8.3
通讯作者：
Bhatraju PK
中科院分区：
文献类型：
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作者：
Cobb NL;Sathe NA;Duan KI;Seitz KP;Thau MR;Sung CC;Morrell ED;Mikacenic C;Kim HN;Liles WC;Luks AM;Town J;Pipavath S;Wurfel MM;Hough CL;West TE;Bhatraju PK
理由：在美国，没有对冠状病毒病（COVID-19）危重患者和流感患者的临床特征、实验室值和结局进行直接比较的报道。目的：比较重症COVID-19患者与季节性流感患者的死亡风险。方法：回顾性分析2019年1月1日至2020年4月15日期间在两家学术医学中心重症监护病房（icu）收治的实验室确诊的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）或甲型或乙型流感感染患者。临床资料通过病案查阅获得。除1例患者外，其余患者随访至出院或死亡。我们使用相对风险回归调整年龄、性别、合并症数量和ICU第1天最大顺序器官衰竭评分，以确定与流感患者相比，COVID-19患者的住院死亡率和器官功能障碍风险。结果：我们发现65例COVID-19危重患者和74例流感患者。两组患者平均（±标准差）年龄分别为60.4±15.7岁和56.8±17.6岁。COVID-19患者更有可能是男性，体重指数更高，患慢性肾病和糖尿病的比例更高。在COVID-19患者中，37%被确定为西班牙裔，而10%的流感患者被确定为西班牙裔。相似比例的患者在入院时出现发烧（约40%）和淋巴细胞减少（约80%）。急性肾损伤和休克需要血管加压药物的发生率在两组之间相似。尽管两组患者对有创机械通气的需求也相似，但与流感患者相比，COVID-19患者的氧合改善较慢，机械通气持续时间较长，拔管率较低。COVID-19患者的住院死亡率为40%，流感患者的住院死亡率为19%（校正相对危险度为2.13；95%可信区间为1.24-3.63;P = 0.006）。结论：COVID-19和流感ICU患者对有创机械通气的需求普遍存在。与流感患者相比，ICU中COVID-19患者的呼吸结局更差，包括机械通气持续时间更长。此外，与年龄、性别、合并症和ICU疾病严重程度无关，COVID-19患者住院死亡的风险更高。
Rationale: No direct comparisons of clinical features, laboratory values, and outcomes between critically ill patients with coronavirus disease (COVID-19) and patients with influenza in the United States have been reported. Objectives: To evaluate the risk of mortality comparing critically ill patients with COVID-19 with patients with seasonal influenza. Methods: We retrospectively identified patients admitted to the intensive care units (ICUs) at two academic medical centers with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or influenza A or B infections between January 1, 2019, and April 15, 2020. The clinical data were obtained by medical record review. All patients except one had follow-up to hospital discharge or death. We used relative risk regression adjusting for age, sex, number of comorbidities, and maximum sequential organ failure scores on Day 1 in the ICU to determine the risk of hospital mortality and organ dysfunction in patients with COVID-19 compared with patients with influenza. Results: We identified 65 critically ill patients with COVID-19 and 74 patients with influenza. The mean (±standard deviation) age in each group was 60.4 ± 15.7 and 56.8 ± 17.6 years, respectively. Patients with COVID-19 were more likely to be male, have a higher body mass index, and have higher rates of chronic kidney disease and diabetes. Of the patients with COVID-19, 37% identified as Hispanic, whereas 10% of the patients with influenza identified as Hispanic. A similar proportion of patients had fevers (∼40%) and lymphopenia (∼80%) on hospital presentation. The rates of acute kidney injury and shock requiring vasopressors were similar between the groups. Although the need for invasive mechanical ventilation was also similar in both groups, patients with COVID-19 had slower improvements in oxygenation, longer durations of mechanical ventilation, and lower rates of extubation than patients with influenza. The hospital mortality was 40% in patients with COVID-19 and 19% in patients with influenza (adjusted relative risk, 2.13; 95% confidence interval, 1.24–3.63; P = 0.006). Conclusions: The need for invasive mechanical ventilation was common in patients in the ICU for COVID-19 and influenza. Compared with those with influenza, patients in the ICU with COVID-19 had worse respiratory outcomes, including longer duration of mechanical ventilation. In addition, patients with COVID-19 were at greater risk for in-hospital mortality, independent of age, sex, comorbidities, and ICU severity of illness.