SARS-CoV-2感染患者不良结局风险的长期趋势

G. Ioannou, A. O’Hare, K. Berry, V. Fan, K. Crothers, M. Eastment, E. Locke, P. Green, Javeed A. Shah, J. Dominitz
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引用次数: 10

摘要

目的:我们旨在描述2020年2月至9月期间在国家医疗保健系统中SARS-CoV-2检测呈阳性的患者不良结局发生率的趋势。背景:美国退伍军人事务国家医疗保健系统。参与者:在2020年2月28日至2020年9月30日期间对SARS-CoV-2检测呈阳性的VA医疗保健系统的参与者(n=55,952)。结果:检测呈阳性后30天内死亡、住院、入住重症监护病房(ICU)并进行机械通气。在每个月感染的患者中检查这些结果的发生率,并使用中断时间序列分析评估趋势。结果:2020年2月至7月,在美国第一波流感大流行期间,30天住院率(44.2%至15.8%)、ICU入院率(20.3%至5.3%)、机械通气率(12.7%至2.2%)和死亡率(12.5%至4.4%)呈明显下降趋势,随后在2020年7月至9月趋于稳定。在对社会人口学特征、合并症和记录的症状进行调整后,以及对住院患者(包括在ICU住院并接受机械通气治疗的亚组中)的实验室检测结果进行额外调整后,这些趋势仍然存在。2 - 9月住院患者中,羟氯喹(56.5% ~ 0%)、阿奇霉素(48.3% ~ 16.6%)、血管加压剂(20.6% ~ 8.7%)和透析(11.6% ~ 3.8%)的使用率下降,地塞米松(3.4% ~ 53.1%)、其他皮质激素(4.9% ~ 29.0%)和瑞德西韦(1.7% ~ 45.4%)的使用率上升。结论:在美国大型国家医疗保健系统中,SARS-CoV-2检测呈阳性的患者中,一系列不良后果的风险在2月至7月期间显着降低,随后在7月至9月期间趋于稳定。这些趋势不能用基线患者特征的变化来解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trends over time in the risk of adverse outcomes among patients with SARS-CoV-2 infection
Objectives: We aimed to describe trends in the incidence of adverse outcomes among patients who tested positive for SARS-CoV-2 between February and September 2020 within a national healthcare system. Setting: US Veterans Affairs national healthcare system. Participants: Enrollees in the VA healthcare system who tested positive for SARS-CoV-2 between 2/28/2020 and 9/30/2020 (n=55,952). Outcomes: Death, hospitalization, intensive care unit (ICU) admission and mechanical ventilation within 30 days of testing positive. The incidence of these outcomes was examined among patients infected each month and trends were evaluated using an interrupted time-series analysis. Results: Between February and July 2020, during the first wave of the US pandemic, there were marked downward trends in the 30-day incidence of hospitalization (44.2% to 15.8%), ICU admission (20.3% to 5.3%), mechanical ventilation (12.7% to 2.2%), and death (12.5% to 4.4%), with subsequent stabilization between July and September 2020. These trends persisted after adjustment for sociodemographic characteristics, comorbid conditions, and documented symptoms and after additional adjustment for laboratory test results among hospitalized patients, including among subgroups admitted to the ICU and treated with mechanical ventilation. Among hospitalized patients, use of hydroxychloroquine (56.5% to 0%), azithromycin (48.3% to 16.6%) vasopressors (20.6% to 8.7%), and dialysis (11.6% to 3.8%) decreased while use of dexamethasone (3.4% to 53.1%), other corticosteroids (4.9% to 29.0%) and remdesivir (1.7% to 45.4%) increased from February to September. Conclusions: Among patients who tested positive for SARS-CoV-2 in a large national US healthcare system, risk for a range of adverse outcomes decreased markedly between February and July, with subsequent stabilization from July to September. These trends were not explained by changes in measured baseline patient characteristics.
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