Epidemiology, clinical and biological characteristics, and prognosis of critically ill COVID 19 patients: a single-center experience through 4 successive waves.

IF 8.5 Q1 RESPIRATORY SYSTEM
Sonia Tchakerian, Noémie Besnard, Vincent Brunot, Valérie Moulaire, Nacim Benchabane, Laura Platon, Delphine Daubin, Philippe Corne, Sonia Machado, Boris Jung, Eddine Bendiab, Liliane Landreau, Corrine Pelle, Romaric Larcher, Kada Klouche
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Abstract

Objective: The aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality.

Materials and methods: This single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis.

Results: Over the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82-88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%.

Conclusion: In this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.

COVID 19 重症患者的流行病学、临床和生物学特征及预后:一个中心连续 4 次的经验。
研究目的本研究旨在描述因 SARS-CoV-2 导致重症监护室收治的重症肺炎患者的特征,并根据连续波次对其进行比较,同时确定发病率和死亡率的预后因素:这项单中心回顾性观察描述性研究于 2020 年 3 月 10 日至 2021 年 10 月 17 日进行。研究纳入了所有因 SARS-CoV-2 肺炎导致急性呼吸衰竭而入院的成人患者。通过对呼吸道标本进行 RT-PCR 检测来确诊 COVID 19。主要终点是重症监护病房死亡率。次要终点是呼吸机相关肺炎(VAP)或支气管肺曲霉菌病的发生率:在研究期间,共纳入了 437 名患者,其中 282 名患者(65%)的呼吸机使用时间为 9 [5;20] 天。在研究人群中,38%的患者因一次或多次发作的 VAP 而接受治疗,22 人(5%)因支气管肺曲霉菌病而接受治疗。第一波的重症监护病房死亡率为 26%,随后下降并稳定在 10%左右(P = 0.02)。入院时年龄、Charlson 指数、SOFA 评分和乳酸血症的增加都是死亡率的预测因素。90 天的存活率为 85%(95% CI 82-88),不受 VAP 存在的影响。然而,支气管肺曲霉菌病的发生使死亡率上升至 36%:在这项研究中,我们观察到的死亡率低于之前报道的死亡率。死亡率的风险因素主要包括年龄和既往的合并症。这些重症 Covid 19 患者的预后在四个波次中均有所改善,这凸显了疫苗接种和地塞米松可能产生的有益影响。
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
Pneumonia
Pneumonia RESPIRATORY SYSTEM-
自引率
1.50%
发文量
7
审稿时长
11 weeks
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