新冠肺炎危重患者机械通气合并院内肺炎α和Omicron变异的临床结果比较

IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM
Chuan-Yen Sun, Jhong-Ru Huang, Hsiao-Chin Shen, Ying-Ting Liao, Hung-Jui Ko, Chih-Jung Chang, Yuh-Min Chen, Jia-Yih Feng, Wei-Chih Chen, Kuang-Yao Yang
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引用次数: 0

摘要

背景:严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起冠状病毒病2019 (COVID-19),这是一种导致全球数百万人死亡的大流行。需要插管并发展为医院性肺炎(通常由革兰氏阴性杆菌引起)的COVID-19危重症患者的死亡率高于未患医院性肺炎的患者。目的:比较机械通气(MV)合并院内肺炎危重症患者α型和Omicron型SARS-CoV-2变异的临床特征、结局及相关危险因素。设计:这是一项回顾性单中心队列研究。方法:本观察性研究于2021年5月至2022年9月在台湾台北荣民总医院进行。纳入了确诊为SARS-CoV-2感染并气管插管合并细菌性肺炎的危重患者。收集和分析了人口统计数据、实验室结果和治疗信息。此外,研究了不同SARS-CoV-2变体的临床结果。结果:本研究纳入了94例需要插管并入住重症监护病房(ICU)的COVID-19危重患者。Alpha组的SARS-CoV-2病毒脱落时间、MV天数和ICU住院时间更长,而Omicron组的年龄更大,合合症更多,APACHE II评分更高,住院死亡率更高(47.0%比25.0%,p = 0.047)。然而,院内死亡的独立危险因素包括恶性肿瘤、血清白蛋白水平较低和缺乏瑞德西韦治疗(SARS-CoV-2变体除外)。结论:我们的研究发现,与α变异相比,感染Omicron变异的重症COVID-19中MV和继发性肺炎患者的住院死亡率更高;然而,院内死亡的真正独立危险因素是恶性肿瘤、较低的血清白蛋白水平和缺乏瑞德西韦治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of clinical outcomes in critically ill COVID-19 patients on mechanical ventilation with nosocomial pneumonia between Alpha and Omicron variants.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a pandemic that has resulted in millions of deaths worldwide. Critically ill COVID-19 patients who require intubation and develop nosocomial pneumonia, commonly caused by gram-negative bacilli, have a higher mortality rate than those without nosocomial pneumonia.

Objectives: The aim of this study is to compare the clinical characteristics and outcomes and associated risk factors of Alpha and Omicron SARS-CoV-2 variants in critically ill patients on mechanical ventilation (MV) with nosocomial pneumonia.

Design: This is a retrospective single-center cohort study.

Methods: This observational study was conducted at Taipei Veterans General Hospital, Taiwan from May 2021 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and intubated on a MV with bacterial pneumonia were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes among different SARS-CoV-2 variants were examined.

Results: This study included 94 critically ill COVID-19 patients who required intubation and intensive care unit (ICU) admission. The Alpha group had a longer duration of SARS-CoV-2 viral shedding, MV days, and ICU stay, while the Omicron group had older age, more comorbidities, higher APACHE II scores, and higher in-hospital mortality (47.0% versus 25.0%, p = 0.047). However, independent risk factors for in-hospital mortality included malignancy, lower serum albumin levels, and lack of Remdesivir treatment, except for the SARS-CoV-2 variant.

Conclusion: Our study discovered a higher in-hospital mortality rate in severe COVID-19 patients with MV and secondary pneumonia infected with the Omicron variant compared to the Alpha variant; however, real independent risk factors for in-hospital mortality are malignancy, lower serum albumin level, and lack of Remdesivir treatment.

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来源期刊
CiteScore
6.90
自引率
0.00%
发文量
57
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Respiratory Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of respiratory disease.
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