Clinical Trends Among US Adults Hospitalized With COVID-19, March to December 2020 A Cross-Sectional Study
Clinical Trends Among US Adults Hospitalized With COVID-19, March to December 2020 A Cross-Sectional Study
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DOI：
10.7326/m21-1991
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发表时间：
2021-10-01
影响因子：
39.2
通讯作者：
Havers, Fiona P.
中科院分区：
文献类型：
--
作者：
Garg, Shikha;Patel, Kadam;Havers, Fiona P.
背景：COVID-19 大流行已导致大量发病率和死亡率。目的：描述因 COVID-19 住院的成人的每月临床趋势。设计：汇总横断面研究。设置：参与 2019 年冠状病毒病相关住院监测网络 (COVID-NET) 的 14 个州的 99 个县。患者：因感染新冠肺炎住院的美国成年人（年龄 >= 18 岁） 2020 年 3 月 1 日至 12 月 31 日期间经实验室确诊的 COVID-19。测量：人口中每 10 万人的每月住院率、重症监护病房 (ICU) 入院率和院内死亡率；按年龄和地点分层的住院患者随机样本中，干预措施的加权百分比的月度趋势，包括 ICU 入院、机械通气和升压药的使用。 结果：在 116 743 名住院的 COVID-19 成人中，中位年龄为 62 岁，50.7% 为男性，40.8% 为非西班牙裔白人。每月住院率（每 10 万人 105.3 人）、入住 ICU（每 10 万人 20.2 人）和死亡率（每 10 万人 11.7 人）在 2020 年 12 月达到峰值。所有 3 种结果的发生率在 65 岁或以上的成年人、男性以及西班牙裔或非西班牙裔黑人中最高。在 18 508 名住院成人样本中，瑞德西韦和全身性皮质类固醇的使用率分别从 3 月份的 1.7% 和 18.9% 增加到 12 月份的 53.8% 和 74.2%。从 3 月（分别为 37.8%、27.8% 和 22.7%）到 12 月（分别为 20.5%、12.3% 和 12.8%），入住 ICU、机械通气和升压药的频率有所下降；从 3 月到 12 月，无创呼吸支持的使用有所增加。 局限性：COVID-NET 覆盖了大约 10% 的美国人口；研究结果可能无法推广到整个国家。结论：2020 年 12 月与 COVID-19 相关的住院率、ICU 入住率和死亡率最高，对应美国大流行的第三次高峰。随着时间的推移，对住院患者进行强化干预管理的频率逐渐减少。这些数据对广泛实施 COVID-19 疫苗之前因 COVID-19 住院的成人的临床趋势进行了纵向评估。
Background: The COVID-19 pandemic has caused substantial morbidity and mortality.Objective: To describe monthly clinical trends among adults hospitalized with COVID-19.Design: Pooled cross-sectional study.Setting: 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET).Patients: U.S. adults (aged >= 18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020.Measurements: Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients.Results: Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December.Limitation: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country.Conclusion: Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines.