Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
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DOI：
10.1001/jama.2020.5394
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发表时间：
2020-04-28
影响因子：
120.7
通讯作者：
Pesenti, Antonio
中科院分区：
文献类型：
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作者：
Grasselli, Giacomo;Zangrillo, Alberto;Pesenti, Antonio
意大利伦巴第省重症监护病房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）感染患者的基线特征和结局是什么？在本回顾性病例系列中，涉及2020年2月20日至3月18日收治的1591例危重患者，99%（1300例患者中的1287例）需要呼吸支持，包括88%的气管内插管和11%的无创通气；ICU死亡率为26%。截至2020年3月25日，意大利伦巴第省实验室确诊2019冠状病毒病（COVID-19）重症监护病房收治的重症患者中，需要机械通气的比例较高，ICU死亡率为26%。2019年12月，一种新型冠状病毒（严重急性呼吸综合征冠状病毒2 [SARS-CoV-2]）在中国出现并在全球蔓延，形成了一场大流行。需要重症监护的感染患者的临床特征信息有限。目的了解意大利伦巴第地区需要重症监护病房（ICU）治疗的2019冠状病毒病（COVID-19）患者特征。设计、环境和参与者回顾性研究了1591例连续实验室确诊的COVID-19患者，这些患者于2020年2月20日至3月18日期间转诊至COVID-19伦巴第ICU网络协调中心（意大利米兰基金会IRCCS Ca' Granda Ospedale Maggiore Policlinico）的ICU住院，并在该网络72家医院的ICU之一接受治疗。最后一次随访日期为2020年3月25日。鼻咽拭子实时逆转录聚合酶链反应（RT-PCR）检测证实SARS-CoV-2感染。收集了人口统计学和临床数据，包括临床管理、呼吸衰竭和患者死亡率的数据。协调中心在伦巴第COVID-19 ICU网络工作人员的电话通话期间将数据记录在电子工作表上。结果纳入研究的1591例患者中位（IQR）年龄为63（56-70）岁，1304例（82%）为男性。在1043例可获得数据的患者中，709例（68%）至少有1种合并症，509例（49%）患有高血压。在1300例可获得呼吸支持数据的患者中，1287例（99% [95% CI, 98%-99%]）需要呼吸支持，其中1150例（88% [95% CI, 87%-90%]）接受机械通气，137例（11% [95% CI, 9%-12%]）接受无创通气。中位呼气末正压（PEEP）为14 (IQR, 12-16) cm H2O， 89%的患者Fio(2)大于50%。中位Pao(2)/Fio(2)为160 （IQR, 114-220）。年轻患者（n = 503，年龄= 64岁）中位PEEP水平无差异（分别为14 [IQR， 12-15]和14 [IQR， 12-16] cm H2O；中位差异为0 [95% CI， 0-0]; P = 0.94）。年轻患者的中位Fio(2)较低：60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%)（中位差值为-10% [95% CI， -14% - 6%]; P = 0.006），年轻患者的中位Pao(2)/Fio(2)较高：163.5 (IQR, 120-230) vs 156 (IQR, 110-205)（中位差值为7 [95% CI， -8 - 22]; P = 0.02）。高血压患者（n = 509）比无高血压患者（n = 526）年龄大（中位[IQR]， 66岁[60-72岁]vs 62岁[54-68岁]；P < 0.001）， Pao(2)/Fio(2)较低（中位[IQR]， 146 [105-214] vs 173[120-222]；中位差为-27 [95% CI， -42 ~ -12]; P = 0.005）。截至2020年3月25日，1581例有ICU处置数据的患者中，920例（58% [95% CI, 56%-61%]）仍在ICU， 256例（16% [95% CI, 14%-18%]）已出院，405例（26% [95% CI, 23%-28%]）已在ICU死亡。老年患者（n = 786；年龄>= 64岁）的死亡率高于年轻患者(n = 795；年龄
Question What are the baseline characteristics and outcomes of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to intensive care units (ICUs) in Lombardy, Italy? Findings In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%. Meaning In this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed coronavirus disease 2019 (COVID-19), a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020.Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio(2) was greater than 50% in 89% of patients. The median Pao(2)/Fio(2) was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged = 64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio(2) was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao(2)/Fio(2) was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao(2)/Fio(2) (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age >= 64 years) had higher mortality than younger patients (n = 795; age