COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany.
COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany.
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DOI：
10.1371/journal.pone.0242127
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
COVID UKF Study Group
中科院分区：
文献类型：
--
作者：
Rieg S;von Cube M;Kalbhenn J;Utzolino S;Pernice K;Bechet L;Baur J;Lang CN;Wagner D;Wolkewitz M;Kern WV;Biever P;COVID UKF Study Group
报告的2019冠状病毒病（COVID-19）住院患者死亡率差异很大，特别是重症患者。到目前为止，尚未对COVID-19住院死亡率和最先进护理下的死亡模式进行系统研究。这项回顾性观察性单中心队列研究是在弗赖堡大学医学中心实施非限制性、动态三级护理模式后进行的，弗莱堡大学医学中心是一家经验丰富的急性呼吸窘迫综合征（ARDS）和体外膜肺氧合（ECMO）转诊中心。所有PCR证实的SARS-CoV-2感染的住院患者均纳入研究。主要终点为院内死亡率，次要终点包括主要并发症和死亡方式。对竞争风险模型进行了多状态分析和考克斯回归分析。死亡模式由两名独立审查员确定。在2月25日至5月8日期间，213名患者被纳入分析。中位年龄为65岁，129例患者（61%）为男性。70例（33%）患者入住重症监护室（ICU），其中57例（81%）患者接受机械通气，23例（33%）患者接受ECMO支持。使用多状态方法，整个队列在COVID-19发病后90天内死亡的估计概率为24%。如果考虑入组研究时的护理水平，如果患者最初在普通病房，则死亡概率为16%，如果在重症监护室（ICU）为47%，如果在入组研究时需要机械通气，则为57%。年龄≥65岁和男性是院内死亡的预测因素。主要并发症-由两名独立评审员判断-确定死亡模式为多器官衰竭、感染性休克、血栓栓塞和出血并发症。在动态护理模式下，与COVID-19相关的住院死亡率仍然很高。在缺乏强效抗病毒药物的情况下，应研究缓解或预防已确定并发症的策略。在这种情况下，多州分析使护理模式和治疗策略的比较，并允许估计和分配卫生保健资源。
Reported mortality of hospitalised Coronavirus Disease-2019 (COVID-19) patients varies substantially, particularly in critically ill patients. So far COVID-19 in-hospital mortality and modes of death under state of the art care have not been systematically studied. This retrospective observational monocenter cohort study was performed after implementation of a non-restricted, dynamic tertiary care model at the University Medical Center Freiburg, an experienced acute respiratory distress syndrome (ARDS) and extracorporeal membrane-oxygenation (ECMO) referral center. All hospitalised patients with PCR-confirmed SARS-CoV-2 infection were included. The primary endpoint was in-hospital mortality, secondary endpoints included major complications and modes of death. A multistate analysis and a Cox regression analysis for competing risk models were performed. Modes of death were determined by two independent reviewers. Between February 25, and May 8, 213 patients were included in the analysis. The median age was 65 years, 129 patients (61%) were male. 70 patients (33%) were admitted to the intensive care unit (ICU), of which 57 patients (81%) received mechanical ventilation and 23 patients (33%) ECMO support. Using multistate methodology, the estimated probability to die within 90 days after COVID-19 onset was 24% in the whole cohort. If the levels of care at time of study entry were accounted for, the probabilities to die were 16% if the patient was initially on a regular ward, 47% if in the intensive care unit (ICU) and 57% if mechanical ventilation was required at study entry. Age ≥65 years and male sex were predictors for in-hospital death. Predominant complications–as judged by two independent reviewers–determining modes of death were multi-organ failure, septic shock and thromboembolic and hemorrhagic complications. In a dynamic care model COVID-19-related in-hospital mortality remained very high. In the absence of potent antiviral agents, strategies to alleviate or prevent the identified complications should be investigated. In this context, multistate analyses enable comparison of models-of-care and treatment strategies and allow estimation and allocation of health care resources.
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DOI：
10.1016/s1473-3099(20)30243-7
发表时间：
2020-06-01
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Verity, Robert;Okell, Lucy C;Ferguson, Neil M
通讯作者：
Ferguson, Neil M
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
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影响因子：
105.7
作者：
Docherty, Annemarie B.;Harrison, Ewen M.;Semple, Malcolm G.
通讯作者：
Semple, Malcolm G.
影响因子：
120.7
作者：
Grasselli, Giacomo;Zangrillo, Alberto;Pesenti, Antonio
通讯作者：
Pesenti, Antonio
影响因子：
10.4
作者：
Llitjos, Jean-Francois;Leclerc, Maxime;Merouani, Karim
通讯作者：
Merouani, Karim