Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study.

IF 1.9 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Joseph Mendlovic, Francis B Mimouni
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引用次数: 0

Abstract

Background: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting.

Objective: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel.

Methods: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients.

Results: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)-backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001).

Conclusions: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy.

以色列 COVID-19 通气患者的死亡率与人口统计有关:非干预性观察队列研究。
背景:COVID-19 大流行导致大规模住院率激增。在没有足够医疗资源的情况下,入院人数激增可能会增加死亡率。在全国范围内的大流行背景下,还没有研究探讨过每日呼吸机患者人数对死亡率的影响:本研究旨在确定每日呼吸机患者人数是否会影响以色列全国的 COVID-19 死亡率:我们使用以色列数据库中 2020 年 3 月 11 日至 2021 年 2 月 11 日的全国范围、公共域、基于人群的 COVID-19 住院患者数据进行了一项队列研究。我们纳入了所有 COVID-19 住院病人,根据美国疾病控制和预防中心的分类,他们被分为轻度到重度,无论他们是否进行了机械通气。结果指标为每日死亡率和以呼吸机患者百分比表示的死亡率:在研究期间(2020 年 3 月 11 日至 2021 年 2 月 11 日,共 338 天),715743 名患者感染并经临床确诊为 COVID-19。其中,5577 名(0.78%)患者死亡。共有 3398 名患者因重症 COVID-19 而接受了通气治疗。每日死亡率与每日通气患者人数相关(R2=0.828,P2=0.365,P2=0.4328,PC结论:每名通气患者的日死亡率随着通气患者人数的增加而增加,这表明医疗资源已经饱和。决策者应该意识到,在没有足够资源的情况下扩大医疗服务可能会增加死亡率。各国政府应进行类似的分析,以提供系统饱和度指标,不过要利用这一指标来推动公共政策,可能还需要对这些结果进行进一步验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Interactive Journal of Medical Research
Interactive Journal of Medical Research MEDICINE, RESEARCH & EXPERIMENTAL-
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45
审稿时长
12 weeks
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