Mortality among people hospitalised with covid-19 in Switzerland: a nationwide population-based analysis
Mortality among people hospitalised with covid-19 in Switzerland: a nationwide population-based analysis
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瑞士 covid-19 住院患者的死亡率：基于全国人口的分析
DOI：
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
J. Riou
中科院分区：
文献类型：
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作者：
N. Anderegg;R. Panczak;M. Egger;N. Low;J. Riou
目的：根据流行波、年龄、性别、合并症和重症监护室（ICU）占用情况，调查瑞士因新冠肺炎住院患者的死亡率。设计：以人群为基础的全国性研究。设置：瑞士所有医院的强制性监测报告。参会人员：2020年2月24日至2021年3月1日期间，所有22，648名SARS-CoV-2感染检测呈阳性并在瑞士住院的人都有关于年龄，性别和合并症的完整信息。主要结局指标：按流行波、年龄、性别、共病状况和ICU占用率，对因COVID-19住院的患者进行SARS-CoV-2检测阳性后的生存率，表示为随时间推移和40天的死亡和生存概率的校正风险比（aHR），所有数据均具有95%可信区间（CrI）。结果：在22,648名因新冠肺炎住院的患者中，4,785人（21.1%）死亡。调整了年龄、性别和合并症的贝叶斯生存模型显示，第一波流行期间的生存率低于第二波（40天标准化预测生存概率为76.1% vs 80.5%;死亡的aHR为1.38，95%CrI为1.28至1.48）。在第二波疫情期间，瑞士所有可用ICU床位（认证床位和附加床位）的入住率在51.7%至78.8%之间变化。使用限制性三次样条对生存率和ICU占用率之间的关系进行建模，表明当ICU占用率低于70%时生存率稳定，但当ICU占用率超过70%时生存率较差。在所有可用的ICU床位中，70%的入住率阈值对应于认证床位中约85%的入住率。男性、老年人和合并症患者的生存率降低。与老年人相比，年轻人的共病状况降低了更多的生存率。作为单一的合并症，高血压与较差的生存率无关，但与心血管疾病联合似乎增加了死亡风险。结论：随着时间的推移，新冠肺炎住院后的生存率有所改善，这与重症新冠肺炎的管理改善一致。在瑞士，从约70%的ICU入住率开始，生存率下降，这支持了在ICU满员之前采取措施预防和控制SARS-CoV-2在人群中传播的必要性。
Objectives: To investigate mortality among people hospitalised with covid-19 in Switzerland according to epidemic wave, age, sex, comorbid conditions and intensive care unit (ICU) occupancy. Design: Population-based, national study.Setting: Mandatory surveillance reports from all hospitals in Switzerland. Participants: All 22,648 people who tested positive for SARS-CoV-2 infection and were hospitalised between February 24, 2020 and March 01, 2021 in Switzerland with complete information about age, sex, and comorbidities. Main outcome measures: Survival after positive SARS-CoV-2 test among people hospitalised with covid-19 by epidemic wave, age, sex, comorbid conditions and ICU occupancy, expressed as adjusted hazard ratios (aHR) of death and probability of survival over time and at 40 days, all with 95% credible intervals (CrI). Results: Of 22,648 people hospitalised with covid-19, 4,785 (21.1%) died. Bayesian survival models adjusted for age, sex, and the presence of comorbidity showed that survival was lower during the first epidemic wave than the second (standardised predicted survival probability at 40 days 76.1% versus 80.5%; aHR of death 1.38, 95% CrI 1.28 to 1.48). During the second epidemic wave, occupancy among all available ICU beds (certified beds and add-on beds) in Switzerland varied between 51.7% and 78.8%. Modelling the association between survival and ICU occupancy with restricted cubic splines indicated stable survival when ICU occupancy was below 70%, but worse survival when ICU occupancy exceeded 70%. This threshold of 70% occupancy among total available ICU beds corresponded to around 85% occupancy among certified beds. Survival was decreased for men, older people, and patients with comorbid conditions. Comorbid conditions reduced survival more in younger people than in older people. As single comorbid condition, hypertension was not associated with poorer survival, but appeared to increase the risk of death in combination with a cardiovascular disease. Conclusion: Survival after hospitalisation with covid-19 has improved over time, consistent with improved management of severe covid-19. The decreased survival starting at approximately 70% ICU occupancy in Switzerland supports the need to introduce measures for prevention and control of SARS-CoV-2 transmission in the population far before ICUs are full.