{"title":"大流行期间无COVID-19患者医疗负担和能力变化与临床结局的关系：一项多中心回顾性队列研究","authors":"Masaaki Sakuraya, Tomoyuki Sugimoto, Kazuya Kikutani, Chikashi Takeda, Daisuke Kasugai, Hiromu Okano, Yoshitaka Aoki, Hiroki Shimada, Daisuke Kawakami, Akira Hirata, Takushi Santanda, Masaki Nakane, Junji Kumasawa, Toko Fukushima, Keisuke Ota, Naoki Moriyama, Masatoshi Uchida, Hiromasa Irie, Kenzo Ishii, Keisuke Mataichi, Junji Shiotsuka, Kensuke Sugimoto, Naoya Kobayashi, Reiki Kumashiro, Yukiko Koyama, Nobuaki Shime","doi":"10.1097/CCM.0000000000006785","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The spillover impact of the COVID-19 pandemic on patients without COVID-19 in ICUs should be assessed. We aimed to assess the association of ICUs' medical burden and capacity changes with clinical outcomes in such patients during the COVID-19 pandemic.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Twenty-three ICUs in Japan.</p><p><strong>Patients: </strong>Patients without COVID-19 in ICUs from January 2019 to February 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>These ICUs completed a web-based questionnaire on medical burden and capacity limitations in November 2023, and they were classified as having a limited capacity if their scores exceeded the median; otherwise, they were categorized as having a maintained capacity. The primary outcome was the standardized mortality ratio (SMR), calculated with the Acute Physiology and Chronic Health Evaluation III-j model, compared with the pre-pandemic level. Using individual-level patient data, a generalized linear Poisson mixed-effects model including an offset-time term was employed to assess the association of capacity limitation, the number of patients with COVID-19, and ICU bed occupancy on the day of admission, with hazard ratios for in-hospital death. Nine and fourteen ICUs had a limited capacity (25,568 patients) and a maintained capacity (45,068 patients), respectively. SMRs increased in four epidemic waves in the ICUs with a limited capacity but in only one wave in those with a maintained capacity. After adjustment, capacity limitation (hazard ratio, 1.19; 95% CI, 1.01-1.41; p = 0.04) and the number of patients with severe COVID-19 (per five patients; hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) were associated with in-hospital mortality, but ICU bed occupancy was not.</p><p><strong>Conclusions: </strong>SMRs increased more frequently in ICUs with a limited capacity during the pandemic. Our findings emphasize the need for proactive strategies to mitigate medical burden and capacity limitations for future preparedness.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Medical Burden and Capacity Changes With Clinical Outcomes Among Patients Without COVID-19 During the Pandemic: A Multicenter Retrospective Cohort Study.\",\"authors\":\"Masaaki Sakuraya, Tomoyuki Sugimoto, Kazuya Kikutani, Chikashi Takeda, Daisuke Kasugai, Hiromu Okano, Yoshitaka Aoki, Hiroki Shimada, Daisuke Kawakami, Akira Hirata, Takushi Santanda, Masaki Nakane, Junji Kumasawa, Toko Fukushima, Keisuke Ota, Naoki Moriyama, Masatoshi Uchida, Hiromasa Irie, Kenzo Ishii, Keisuke Mataichi, Junji Shiotsuka, Kensuke Sugimoto, Naoya Kobayashi, Reiki Kumashiro, Yukiko Koyama, Nobuaki Shime\",\"doi\":\"10.1097/CCM.0000000000006785\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The spillover impact of the COVID-19 pandemic on patients without COVID-19 in ICUs should be assessed. We aimed to assess the association of ICUs' medical burden and capacity changes with clinical outcomes in such patients during the COVID-19 pandemic.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Twenty-three ICUs in Japan.</p><p><strong>Patients: </strong>Patients without COVID-19 in ICUs from January 2019 to February 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>These ICUs completed a web-based questionnaire on medical burden and capacity limitations in November 2023, and they were classified as having a limited capacity if their scores exceeded the median; otherwise, they were categorized as having a maintained capacity. The primary outcome was the standardized mortality ratio (SMR), calculated with the Acute Physiology and Chronic Health Evaluation III-j model, compared with the pre-pandemic level. Using individual-level patient data, a generalized linear Poisson mixed-effects model including an offset-time term was employed to assess the association of capacity limitation, the number of patients with COVID-19, and ICU bed occupancy on the day of admission, with hazard ratios for in-hospital death. Nine and fourteen ICUs had a limited capacity (25,568 patients) and a maintained capacity (45,068 patients), respectively. SMRs increased in four epidemic waves in the ICUs with a limited capacity but in only one wave in those with a maintained capacity. After adjustment, capacity limitation (hazard ratio, 1.19; 95% CI, 1.01-1.41; p = 0.04) and the number of patients with severe COVID-19 (per five patients; hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) were associated with in-hospital mortality, but ICU bed occupancy was not.</p><p><strong>Conclusions: </strong>SMRs increased more frequently in ICUs with a limited capacity during the pandemic. Our findings emphasize the need for proactive strategies to mitigate medical burden and capacity limitations for future preparedness.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2025-07-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006785\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006785","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Association of Medical Burden and Capacity Changes With Clinical Outcomes Among Patients Without COVID-19 During the Pandemic: A Multicenter Retrospective Cohort Study.
Objectives: The spillover impact of the COVID-19 pandemic on patients without COVID-19 in ICUs should be assessed. We aimed to assess the association of ICUs' medical burden and capacity changes with clinical outcomes in such patients during the COVID-19 pandemic.
Design: Retrospective cohort study.
Setting: Twenty-three ICUs in Japan.
Patients: Patients without COVID-19 in ICUs from January 2019 to February 2023.
Interventions: None.
Measurements and main results: These ICUs completed a web-based questionnaire on medical burden and capacity limitations in November 2023, and they were classified as having a limited capacity if their scores exceeded the median; otherwise, they were categorized as having a maintained capacity. The primary outcome was the standardized mortality ratio (SMR), calculated with the Acute Physiology and Chronic Health Evaluation III-j model, compared with the pre-pandemic level. Using individual-level patient data, a generalized linear Poisson mixed-effects model including an offset-time term was employed to assess the association of capacity limitation, the number of patients with COVID-19, and ICU bed occupancy on the day of admission, with hazard ratios for in-hospital death. Nine and fourteen ICUs had a limited capacity (25,568 patients) and a maintained capacity (45,068 patients), respectively. SMRs increased in four epidemic waves in the ICUs with a limited capacity but in only one wave in those with a maintained capacity. After adjustment, capacity limitation (hazard ratio, 1.19; 95% CI, 1.01-1.41; p = 0.04) and the number of patients with severe COVID-19 (per five patients; hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) were associated with in-hospital mortality, but ICU bed occupancy was not.
Conclusions: SMRs increased more frequently in ICUs with a limited capacity during the pandemic. Our findings emphasize the need for proactive strategies to mitigate medical burden and capacity limitations for future preparedness.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
