Mortality Rates in a Diverse Cohort of Mechanically Ventilated Patients With Novel Coronavirus in the Urban Midwest.
Mortality Rates in a Diverse Cohort of Mechanically Ventilated Patients With Novel Coronavirus in the Urban Midwest.
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DOI：
10.1097/cce.0000000000000187
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发表时间：
2020-08-01
影响因子：
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通讯作者：
Khan, Babar A
中科院分区：
文献类型：
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作者：
Twigg, Homer L 3rd;Khan, Sikandar H;Khan, Babar A
目的：以前报道的2019年冠状病毒病危重患者死亡率的差异增加了对死亡率和死亡风险因素的额外数据的需求。我们进行了这项研究，以描述2019年3月1日至2019年4月27日期间接受机械通气的冠状病毒病患者的住院时间、死亡率和与住院死亡率相关的危险因素。设计：观察性研究。设置：印第安纳州印第安纳波利斯的两家城市、学术转诊医院。患者或对象：参与者为2019年3月1日至2019年4月27日期间入院的18岁及以上冠状病毒病危重患者。共有242名患者纳入研究，平均年龄为59.6岁(SD，15.5岁)，其中41.7%为女性，45%为非裔美国人。总体队列死亡率为19.8%，机械通气组死亡率为20.5%。与存活的患者相比，死亡的患者年龄更大(死亡：平均年龄72.8年[SD，10.6年]vs活着出院的患者：54.3年[SD，14.8年]；P<；0.001 vs仍在住院：59.5年[SD，14.4年]；p<；0.001)，与存活的患者相比，有更多的并发症(死亡：2[0.5-3]vs存活：1[四分位数范围，0-1]；p=0.001 vs仍住院：1[四分位数范围，0-2]；P=0.015)。年龄较大和终末期肾病与住院死亡风险增加相关：年龄65-74岁(危险比3.1年；95%可信区间，1.2-7.9年)，75岁以上(危险比4.1年；95%可信区间1.6-10.5年)，以及终末期肾病(危险比5.9年；95%可信区间1.3-26.9年)。死亡患者的机械通气中位时间为9.3天(四分位数区间为5.7-13.7天)，死亡患者的ICU中位住院时间为8.7天(四分位数区间为4.0-14.9天)，而出院患者为9.2天(四分位区间为4.0-14.0天)，仍在住院的患者为12.7天(四分位数区间7.2-20.3天)。结论：我们发现2019年机械通气患者的病死率低于以往报道的一些住院时间较长的患者。
OBJECTIVES: Differences in mortality rates previously reported in critically ill patients with coronavirus disease 2019 have increased the need for additional data on mortality and risk factors for death. We conducted this study to describe length of stay, mortality, and risk factors associated with in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019.DESIGN: Observational study.SETTING: Two urban, academic referral hospitals in Indianapolis, Indiana.PATIENTS OR SUBJECTS: Participants were critically ill patients 18 years old and older, admitted with coronavirus disease 2019 between March 1, 2020, and April 27, 2020.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Outcomes included in-hospital mortality, duration of mechanical ventilation, and length of stay. A total of 242 patients were included with mean age of 59.6 years (sd, 15.5 yr), 41.7% female and 45% African American. Mortality in the overall cohort was 19.8% and 20.5% in the mechanically ventilated subset. Patients who died were older compared with those that survived (deceased: mean age, 72.8 yr [sd, 10.6 yr] vs patients discharged alive: 54.3 yr [sd, 14.8 yr]; p < 0.001 vs still hospitalized: 59.5 yr [sd, 14.4 yr]; p < 0.001) and had more comorbidities compared with those that survived (deceased: 2 [0.5-3] vs survived: 1 [interquartile range, 0-1]; p = 0.001 vs still hospitalized: 1 [interquartile range, 0-2]; p = 0.015). Older age and end-stage renal disease were associated with increased hazard of in-hospital mortality: age 65-74 years (hazard ratio, 3.1 yr; 95% CI, 1.2-7.9 yr), age 75+ (hazard ratio, 4.1 yr; 95% CI, 1.6-10.5 yr), and end-stage renal disease (hazard ratio, 5.9 yr; 95% CI, 1.3-26.9 yr). The overall median duration of mechanical ventilation was 9.3 days (interquartile range, 5.7-13.7 d), and median ICU length of stay in those that died was 8.7 days (interquartile range, 4.0-14.9 d), compared with 9.2 days (interquartile range, 4.0-14.0 d) in those discharged alive, and 12.7 days (interquartile range, 7.2-20.3 d) in those still remaining hospitalized.Conclusions:: We found mortality rates in mechanically ventilated patients with coronavirus disease 2019 to be lower than some previously reported with longer lengths of stay.