入住重症监护病房的 COVID-19 患者的临床特征及预后

Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit.

作者信息

Pandit Rahul A, Gagana B N, Vaity Charudatt, Mulakavalupil Bindu, Choudhary Jitendra S, Jain Vivek, Chandan Pramila M, Joshi Harsh

机构信息

Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India.

出版信息

Indian J Crit Care Med. 2021 Sep;25(9):992-1000. doi: 10.5005/jp-journals-10071-23945.

BACKGROUND

Meta-analysis and clinical studies suggest coronavirus disease-2019 (COVID-19) patients in ICU have a high mortality rate of 30-45%, which has evolved as a function of criteria of admission and the management modalities.

MATERIALS AND METHODS

We conducted a retrospective evaluation for characteristics and outcomes in critical care set up across six months.

RESULTS

514 patients (74.3% males and 25.6% females) were evaluated. 9.72% ( = 50) patients expired, 78% ( = 39) were males. Mean age (years) was 57 (±14, range 64, 95% CI 55-58). 65.7% ( = 338) were of age more than 50 years, of which 71.5% ( = 242) were males. Males at 20% higher risk for death than women. (RR = 1.2, 95% CI 0.66-2.31, = 0.61 NS). There was 18% less risk of mortality in female vs male with comorbidities (RR 0.82, 95% CI 0.67-1.12, = 0.32 NS). Risk for mortality in diabetics was significantly increased by 116% vs nondiabetics. (RR 2.16, = 0.0055, 95% CI 1.28-3.67). Highly significant risk of mortality in age group >50 years (3.13 times higher) vs age ≤50 years. (RR 3.18, 95% CI 1.71-8.64, = 0.0003). 50.2% had moderate ARDS at admission. High flow nasal cannula was used in 47.2%. There is 5.79 times more likelihood to be on the ventilator with moderate to severe ARDS vs mild ARDS (RR = 5.79, 95% CI 3.10-11.05, <0.0001). Risk for death was six times higher for patients on ventilator vs not on ventilator (RR = 6.08, 95% CI 3.49-10.59, <0.0001). The mean number of days on ventilator for patients who underwent tracheostomy ( = 49) was 14 days as compared to 6.6 days in patients who were extubated ( = 57) ( <0.0001). P/F ratio had negative correlation with number of days of hospitalisation (Pearson r -0.391, 95% CI -0.46- -0.31, <0.0001). 67% less chances of mortality in patients on steroids (RR = 0.33, 95% CI 0.19-60, = 0.0012). Mean duration of ICU stay (days) was 8 (± 5, range 29, 95% CI 7.5-8.4).

CONCLUSIONS

We observed that a strict adherence to the basic principles of ARDS management resulted in a lower mortality in ICU setting.

HOW TO CITE THIS ARTICLE

Pandit RA, Gagana BN, Vaity C, Mulakavalupil B, Choudhary JS, Jain V, . Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit. Indian J Crit Care Med 2021;25(9):992-1000.

背景

荟萃分析和临床研究表明，入住重症监护病房（ICU）的2019冠状病毒病（COVID-19）患者死亡率较高，为30%-45%，其死亡率会因入院标准和管理方式而有所变化。

材料与方法

我们对六个月内重症监护环境中的患者特征和结局进行了回顾性评估。

结果

共评估了514例患者（男性占74.3%，女性占25.6%）。9.72%（n = 50）的患者死亡，其中78%（n = 39）为男性。平均年龄为57岁（±14，范围64，95%置信区间55-58）。65.7%（n = 338）的患者年龄超过50岁，其中71.5%（n = 242）为男性。男性死亡风险比女性高20%。（风险比率=1.2，95%置信区间0.66-2.31，P = 0.61，无统计学意义）。合并症患者中，女性死亡率比男性低18%（风险比率0.82，95%置信区间0.67-1.12，P = 0.32，无统计学意义）。糖尿病患者的死亡风险比非糖尿病患者显著增加116%。（风险比率2.16，P = 0.0055，95%置信区间1.28-3.67）。年龄>50岁组的死亡风险极高（是≤50岁组的3.13倍）。（风险比率3.18，95%置信区间1.71-8.64，P = 0.0003）。50.2%的患者入院时患有中度急性呼吸窘迫综合征（ARDS）。47.2%的患者使用了高流量鼻导管。与轻度ARDS患者相比，中度至重度ARDS患者使用呼吸机的可能性高5.79倍（风险比率=5.79，95%置信区间3.10-11.05，P<0.0001）。使用呼吸机的患者死亡风险比未使用呼吸机的患者高6倍（风险比率=6.08，95%置信区间3.49-10.59，P<0.0001）。接受气管切开术的患者（n = 49）使用呼吸机的平均天数为14天，而拔管患者（n = 57）为6.6天（P<0.0001）。氧合指数与住院天数呈负相关（皮尔逊相关系数r=-0.391，95%置信区间-0.46--0.31，P<0.0001）。使用类固醇的患者死亡率降低67%（风险比率=0.33，95%置信区间0.19-60，P = 0.0012）。ICU平均住院时间为8天（±5，范围29，95%置信区间7.5-8.4）。