Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort
Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort
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DOI：
10.1016/j.eclinm.2020.100449
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发表时间：
2020-08-01
影响因子：
15.1
通讯作者：
Hilty, Matthias Peter
中科院分区：
文献类型：
--
作者：
Garcia, Pedro David Wendel;Fumeaux, Thierry;Hilty, Matthias Peter
背景资料：2019冠状病毒病（COVID-19）与高疾病负担相关，10%的确诊病例进展为危重病。然而，对危重患者的病程和死亡率的预测因子知之甚少。在经历大流行初期的地区，随着ICU的关键发展，重症监护室中COVID-19患者的国际风险分层（RISC-19-ICU）注册表的创建是为了提供对因COVID-19而发生危重疾病的患者的近实时评估。截至2020年4月22日，RISC-19-ICU登记中心共纳入639例确诊SARS-CoV-2感染的重症患者。其中398人死亡或从ICU出院。ICU死亡率为24%，中位住院时间为12（IQR，5-21）天。74%的患者诊断为ARDS，最小P/F比为110（IQR，80-148）。57%的患者采用俯卧位、ECCO 2 R或ECMO。265例（67%）患者接受了标签外治疗，在该亚组中观察到89%的血流感染（n = 66; RR-3.2，95% CI [1.7-6.0]）。尽管在ICU存活者和非存活者中PCT和IL-6水平在整个ICU住院期间保持相似（p = 0.35，0.34），但CRP、肌酐、肌钙蛋白、D-二聚体、乳酸、中性粒细胞计数、P/F比在最初7天内出现差异（p
Background: Coronavirus disease 2019 (COVID-19) is associated with a high disease burden with 10% of confirmed cases progressing towards critical illness. Nevertheless, the disease course and predictors of mortality in critically ill patients are poorly understood.Methods: Following the critical developments in ICUs in regions experiencing early inception of the pandemic, the European-based, international Risk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry was created to provide near real-time assessment of patients developing critical illness due to COVID-19.Findings: As of April 22, 2020, 639 critically ill patients with confirmed SARS-CoV-2 infection were included in the RISC-19-ICU registry. Of these, 398 had deceased or been discharged from the ICU. ICU-mortality was 24%, median length of stay 12 (IQR, 5-21) days. ARDS was diagnosed in 74%, with a minimum P/F-ratio of 110 (IQR, 80-148). Prone positioning, ECCO2R, or ECMO were applied in 57%. Off-label therapies were prescribed in 265 (67%) patients, and 89% of all bloodstream infections were observed in this subgroup (n = 66; RR-3.2, 95% CI [1.7-6.0]). While PCT and IL-6 levels remained similar in ICU survivors and non-survivors throughout the ICU stay (p = 0.35, 0.34), CRP, creatinine, troponin, D-dimer, lactate, neutrophil count, P/F-ratio diverged within the first seven days (p