Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU: A Systematic Review and Meta-analysis.
Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU: A Systematic Review and Meta-analysis.
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DOI：
10.1016/j.chest.2020.10.014
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发表时间：
2021-03
期刊：
影响因子：
9.6
通讯作者：
Plummer MP
中科院分区：
文献类型：
--
作者：
Tan E;Song J;Deane AM;Plummer MP
2019冠状病毒病（COVID-19）大流行对全球重症监护服务带来前所未有的负担。重症COVID-19患者入住ICU的死亡和风险因素的全球点估计值是多少？在本系统性综述和荟萃分析中，检索了Medline、Embase和科克伦图书馆，检索时间截止至2020年8月1日。使用随机效应模型计算受试者特征、临床特征和结局数据的合并患病率。亚组分析基于地理分布、研究类型、质量评估、样本量、结束日期和患者分布。报告确诊为COVID-19的成人患者（年龄> 18岁）入住ICU的院内死亡率的研究符合研究资格标准。对于非随机研究，采用纽卡斯尔渥太华量表进行关键性评价。纳入了来自四大洲17个国家的16，561例患者的45项研究。入住ICU的COVID-19患者的平均年龄为62.6岁（95% CI，60.4 - 64.7）。常见合并症包括高血压（49.5%; 95% CI，44.9 - 54.0）和糖尿病（26.6%; 95% CI，22.7 - 30.8）。超过四分之三的病例发生了ARDS（76.1%; 95% CI，65.7 - 85.2）。67.7%需要有创机械通气（95% CI，59.1 - 75.7），65.9%的病例接受血管加压药支持（95% CI，52.4 - 78.4），16.9%的病例接受肾脏替代治疗（95% CI，12.1 - 22.2），体外膜肺氧合为6.4%（95% CI，4.1 - 9.1）。ICU和住院时间分别为10.8天（95%CI，9.3 - 18.4）和19.1天（95%CI，16.3 - 21.9），住院死亡率为28.1%（95%CI，23.4 - 33.0; I2 = 96%）。未观察到显著的亚组效应。入住ICU的COVID-19重症患者需要大量器官支持以及长期ICU和医院级护理。全球因严重COVID-19死亡的汇总估计数<1/3。
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented burden on the delivery of intensive care services worldwide. What is the global point estimate of deaths and risk factors for patients who are admitted to ICUs with severe COVID-19? In this systematic review and meta-analysis Medline, Embase, and the Cochrane library were searched up to August 1, 2020. Pooled prevalence of participant characteristics, clinical features, and outcome data was calculated with the use of random effects models. Subgroup analyses were based on geographic distribution, study type, quality assessment, sample size, end date, and patient disposition. Studies that reported in-hospital mortality rate of adult patients (age >18 years) with confirmed COVID-19 admitted to an ICU met study eligibility criteria. Critical evaluation was performed with the Newcastle Ottawa Scale for nonrandomized studies. Forty-five studies with 16,561 patients from 17 countries across four continents were included. Patients with COVID-19 who were admitted to ICUs had a mean age of 62.6 years (95% CI, 60.4-64.7). Common comorbidities included hypertension (49.5%; 95% CI, 44.9-54.0) and diabetes mellitus (26.6%; 95% CI, 22.7-30.8). More than three-quarters of cases experienced the development of ARDS (76.1%; 95% CI, 65.7-85.2). Invasive mechanical ventilation was required in 67.7% (95% CI, 59.1-75.7) of case, vasopressor support in 65.9% (95% CI, 52.4-78.4) of cases, renal replacement therapy in 16.9% (95% CI, 12.1-22.2) of cases, and extracorporeal membrane oxygenation in 6.4% (95% CI, 4.1-9.1) of cases. The duration of ICU and hospital admission was 10.8 days (95% CI, 9.3-18.4) and 19.1 days (95% CI, 16.3-21.9), respectively, with in-hospital mortality rate of 28.1% (95% CI, 23.4-33.0; I2 = 96%). No significant subgroup effect was observed. Critically ill patients with COVID-19 who are admitted to the ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global death from severe COVID-19 is <1 in 3.
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