COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis.
COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis.
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DOI：
10.3390/medsci9010006
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发表时间：
2021-02-04
期刊：
影响因子：
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通讯作者：
Duncan CJA
中科院分区：
文献类型：
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作者：
Baker KF;Hanrath AT;van der Loeff IS;Tee SA;Capstick R;Marchitelli G;Li A;Barr A;Eid A;Ahmed S;Bajwa D;Mohammed O;Alderson N;Lendrem C;Lendrem DW;Covid-Control Group;Covid-Clinical Group;Pareja-Cebrian L;Welch A;Field J;Payne BAI;Taha Y;Price DA;Gibbins C;Schmid ML;Hunter E;Duncan CJA
最近的大型国内和国际队列描述了住院的 COVID-19 患者的基线特征和结果，但这些报告的粒度有限。我们的目的是提供英国 COVID-19 队列的详细描述，重点关注管理和结果。我们对 2020 年 1 月 31 日至 4 月 16 日期间连续住院的 SARS-CoV-2 PCR 确诊的 COVID-19 成人患者的临床管理和 28 天结果进行了回顾性单中心分析。总共发现 316 例病例。大多数患者是患有多种合并症的老年人（中位年龄 75 岁）。四分之一是从住院或护理机构入院的。 316 人中，死亡率为 84 人（26.6%）。大多数死亡发生在已确定住院治疗上限并在适当情况下为其提供临终关怀和专业姑息治疗投入的患者中。 56岁以下患者中没有发生死亡。在考虑患者意愿、病前虚弱和合并症后，开始呼吸支持的决定是个体化的。总共有 59 名患者（18%）被送入重症监护室，其中 31 名患者（占队列总数的 10%）需要插管。多元逻辑回归确定了死亡与年龄、虚弱和疾病严重程度之间的关联，其中年龄是最重要的因素（比值比每年增加 1.07 [95% CI 1.03–1.10]，p < 0.001）。这些发现为结果数据提供了重要的临床背景。死亡率与年龄增长有关。大多数死亡是预期的，并且发生在预先决定治疗上限的患者中。
Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We performed a retrospective single-centre analysis of clinical management and 28-day outcomes of consecutive adult inpatients with SARS-CoV-2 PCR-confirmed COVID-19 from 31 January to 16 April 2020 inclusive. In total, 316 cases were identified. Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Mortality was 84 out of 316 (26.6%). Most deaths occurred in patients in whom a ceiling of inpatient treatment had been determined and for whom end of life care and specialist palliative care input was provided where appropriate. No deaths occurred in patients aged under 56 years. Decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities. In total, 59 (18%) patients were admitted to intensive care, of which 31 (10% overall cohort) required intubation. Multiple logistic regression identified associations between death and age, frailty, and disease severity, with age as the most significant factor (odds ratio 1.07 [95% CI 1.03–1.10] per year increase, p < 0.001). These findings provide important clinical context to outcome data. Mortality was associated with increasing age. Most deaths were anticipated and occurred in patients with advance decisions on ceilings of treatment.