重症COVID-19疾病的临床表现、ICU管理和结局——一项前瞻性观察研究

S. Prakash
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引用次数: 0

摘要

目的:我们进行了一项前瞻性观察性研究,以描述入住重症监护病房(ICU)的中重度冠状病毒病患者的临床特征、管理和结局。方法:研究于2020年7月1日至2020年12月31日进行。入院标准为新型冠状病毒(SARS-CoV-2)逆转录-聚合酶链反应(RT-PCR)阳性,有氧或无氧时血氧饱和度低于90%。结果:共纳入621例患者(中位年龄59岁[四分位数间距{IQR}, 48-68];75.8%为男性。常见合并症为高血压(323例[52%])和糖尿病。96例(15.5%)患者接受机械通气,18例(2.9%)患者接受肾脏替代治疗,223例(36%)患者死亡。非幸存者的中位年龄明显高于[63岁(IQR 55-71)]与57岁(IQR 46-66)] (p < 0.001)。缺氧(血氧饱和度< 90%)和呼吸短促提示即将发生的呼吸衰竭是最常见的需要进入ICU的症状。低绝对淋巴细胞计数(ALC)和诊断后持续7天的高水平炎症生物标志物与无法生存显著相关。多因素logistic回归分析显示,呼吸急促(SOB)、缺氧(含氧SpO2 < 90%)、使用神经肌肉阻滞剂和慢性肾脏疾病是与死亡率相关的独立危险因素,严重程度评分(APACHE和SOFA)也是如此。结论:该单中心病例系列提供了入住COVID-19 ICU的确诊COVID-19患者的临床特征和结局。这些发现对于指导研究和为未来的大流行做准备具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical presentation, ICU management and outcome in severe COVID-19 disease – A prospective observational study
Aim: We conducted a prospective, observational study to describe the clinical characteristics, management, and outcomes of patients with moderate to severe coronavirus disease admitted to the Intensive Care Unit (ICU). Methods: The study was conducted from 1st July 2020 to 31st December 2020. The criteria for ICU admission included a positive Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) for the novel Coronavirus (SARS-CoV-2) and oxygen saturation of less than 90% with or without oxygen. Results: A total of 621 patients were included (median age, 59 years [interquartile range {IQR}, 48-68]; 75.8% were males. The common comorbidities were hypertension (323 [52%]), and diabetes mellitus. 96 (15.5%) patients underwent mechanical ventilation, 18 (2.9%) received renal replacement therapy, and 223 (36%) died. The median age in non-survivors was significantly higher [63 years (IQR 55-71)] vs. 57 years (IQR 46-66)] (p < 0.001). Hypoxia (oxygen saturation (SpO2 < 90%) and shortness of breath suggestive of impending respiratory failure were the most common symptoms necessitating ICU admission. A low absolute lymphocyte count (ALC), and high levels of inflammatory biomarkers which persisted for seven days after diagnosis were significantly associated with non-survival. Multivariate logistic regression analysis showed shortness of breath (SOB), hypoxia (SpO2 < 90% on oxygen), use of neuromuscular blockers, and chronic kidney disease as independent risk factors associated with mortality as were the severity scores (APACHE and SOFA). Conclusion: This single-center case series provides clinical characteristics and outcomes of patients with confirmed COVID-19 disease admitted to the COVID ICU. These findings are important for guiding research and preparing for future pandemics.
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