Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic.
Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2021.8828
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发表时间：
2021-05-03
影响因子：
13.8
通讯作者：
Murray C
中科院分区：
文献类型：
--
作者：
Roth GA;Emmons-Bell S;Alger HM;Bradley SM;Das SR;de Lemos JA;Gakidou E;Elkind MSV;Hay S;Hall JL;Johnson CO;Morrow DA;Rodriguez F;Rutan C;Shakil S;Sorensen R;Stevens L;Wang TY;Walchok J;Williams J;Murray C
在COVID-19大流行的前9个月，哪些因素与观察到的美国住院死亡率趋势相关？在这项20736例患者的队列研究中，2020年3月至11月期间，美国的住院死亡率下降，即使考虑到入院时患者年龄、性别、合并症和疾病严重程度的变化。住院和重症监护室的住院时间和机械通气的使用随着时间的推移而减少，而糖皮质激素和瑞德西韦的使用则增加。COVID-19患者的年龄、性别、合并症和疾病严重程度的变化并不能完全解释COVID-19大流行前9个月期间观察到的住院死亡率下降。COVID-19的住院死亡率很高，但在美国的选定地区似乎正在下降。目前尚不清楚这是否是因为入院病人的特征发生了变化。描述考虑个体患者特征后随时间变化的住院死亡率。这是一项回顾性队列研究，纳入了20736名确诊为COVID-19的成年人，他们被纳入美国心脏协会COVID-19心血管疾病登记处，并于2020年3月至11月期间在31个州的107家急诊医院住院。然后使用多重混合效应逻辑回归来估计院内死亡的几率，根据患者年龄、性别、体重指数和病史以及生命体征、补充氧气的使用、入院时是否存在肺部浸润和医院地点进行调整。2020年4个时期的住院死亡暴露调整。该登记研究包括2020年3月至11月期间因COVID-19住院的20736名患者（9524名女性[45.9%];平均[SD]年龄为61.2 [17.9]岁）; 3271名患者（15.8%）在医院死亡。3月和4月的死亡率为19.1%，5月和6月为11.9%，7月和8月为11.0%，9月至11月为10.8%。与3月和4月相比，5月和6月住院死亡的调整优势比明显降低（比值比，0.66; 95% CI，0.58-0.76; P < .001），7月和8月（比值比，0.58; 95%CI，0.49-0.69; P <0.001），9月至11月（比值比，0.59; 95%CI，0.47-0.73）。在这项队列研究中，2020年3月和4月登记患者的高住院COVID-19死亡率到6月下降了三分之一以上，并在11月保持接近该比率。即使在调整了年龄、性别、病史和COVID-19疾病严重程度之后，3月和4月以及随后几个月之间的死亡率差异仍然存在，似乎与入院患者特征的变化无关。这项对美国心脏协会COVID-19心血管疾病登记处纳入的患者进行的队列研究评估了在大流行的前9个月期间，住院COVID-19死亡率的任何变化是否与COVID-19患者的个体特征相关。
What factors are associated with observed trends in the in-hospital mortality rates in the United States during the first 9 months of the COVID-19 pandemic? In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased. Changes in age, sex, comorbidities, and disease severity among patients with COVID-19 do not fully explain the decrease in the in-hospital mortality rates observed during the first 9 months of the COVID-19 pandemic. In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted. To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics. This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site. In-hospital death adjusted for exposures for 4 periods in 2020. The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted. This cohort study of patients included in the US American Heart Association COVID-19 Cardiovascular Disease Registry evaluates whether any changes in the in-hospital COVID-19 mortality rates during the first 9 months of the pandemic are associated with individual characteristics of patients with COVID-19.
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影响因子：
8.1
作者：
Wang, Ke;Zhao, Wei;Duan, Jun
通讯作者：
Duan, Jun
影响因子：
8.8
作者：
Dennis JM;McGovern AP;Vollmer SJ;Mateen BA
通讯作者：
Mateen BA
DOI：
10.1161/circoutcomes.120.006967
发表时间：
2020-08
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Alger HM;Rutan C;Williams JH 4th;Walchok JG;Bolles M;Hall JL;Bradley SM;Elkind MSV;Rodriguez F;Wang TY;Morrow DA;Das SR;de Lemos JA
通讯作者：
de Lemos JA
影响因子：
120.7
作者：
Sterne, Jonathan A. C.;Murthy, Srinivas;Marshall, John C.
通讯作者：
Marshall, John C.
影响因子：
37.8
作者：
Hendren, Nicholas S.;de Lemos, James A.;Grodin, Justin L.
通讯作者：
Grodin, Justin L.