Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months.
Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months.
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DOI：
10.1007/s00134-021-06388-0
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发表时间：
2021-05
影响因子：
38.9
通讯作者：
Bozza FA
中科院分区：
文献类型：
--
作者：
Kurtz P;Bastos LSL;Dantas LF;Zampieri FG;Soares M;Hamacher S;Salluh JIF;Bozza FA
COVID-19患者的临床特征和管理在大流行期间发生了变化，可能会改变他们的结果。我们分析了COVID-19重症患者死亡率变化与临床特征和呼吸支持策略的相关性。2020年2月27日至10月28日期间，在126个巴西重症监护病房住院的经RT-PCR确诊的COVID-19患者的多中心队列。评估死亡的时间变化，我们确定了不同的时间段。我们使用随机效应多变量考克斯回归和逆概率加权法评估了特征和呼吸支持策略与60天住院死亡率的相关性。在13，301名确诊的COVID-19患者中，60天住院死亡率为13%。在确定的四个时间段内，年轻患者越来越常见，无创呼吸支持的使用越来越多，60天住院死亡率在最后两个时间段内下降。4188例患者接受了高级呼吸支持（无创或有创），其中42%仅接受有创机械通气，37%仅接受无创呼吸支持，21%无创支持失败并插管。在调整器官功能障碍评分和发病前状况后，我们发现年龄较小、无虚弱和使用非侵入性呼吸支持（NIRS）作为第一支持策略与生存率改善独立相关（NIRS第一风险比[95%置信区间]，0.59 [0.54-0.65]，p < 0.001）。在大流行的头8个月，年龄和死亡率有所下降。使用NIRS作为第一个呼吸支持措施与生存率相关，但因果关系的推断受到我们数据的观察性质的限制。在线版本包含补充材料，可通过10.1007/s 00134 -021-06388-0获得。
Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27th and October 28th, 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting. Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54–0.65], p < 0.001). Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data. The online version contains supplementary material available at 10.1007/s00134-021-06388-0.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
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影响因子：
38.9
作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
通讯作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
影响因子：
39
作者：
Gupta, Shruti;Hayek, Salim S.;Leaf, David E.
通讯作者：
Leaf, David E.
DOI：
10.1016/s2213-2600(20)30560-9
发表时间：
2021-04
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Ranzani OT;Bastos LSL;Gelli JGM;Marchesi JF;Baião F;Hamacher S;Bozza FA
通讯作者：
Bozza FA
影响因子：
11.7
作者：
Winck, J. C.;Ambrosino, N.
通讯作者：
Ambrosino, N.