Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Anesi George L, Jablonski Juliane, Harhay Michael O, Atkins Joshua H, Bajaj Jasmeet, Baston Cameron, Brennan Patrick J, Candeloro Christina L, Catalano Lauren M, Cereda Maurizio F, Chandler John M, Christie Jason D, Collins Tara, Courtright Katherine R, Fuchs Barry D, Gordon Emily, Greenwood John C, Gudowski Steven, Hanish Asaf, Hanson C William, Heuer Monica, Kinniry Paul, Kornfield Zev Noah, Kruse Gregory B, Lane-Fall Meghan, Martin Niels D, Mikkelsen Mark E, Negoianu Dan, Pascual Jose L, Patel Maulik B, Pugliese Steven C, Qasim Zaffer A, Reilly John P, Salmon John, Schweickert William D, Scott Michael J, Shashaty Michael G S, Sicoutris Corinna P, Wang John K, Wang Wei, Wani Arshad A, Anderson Brian J, Gutsche Jacob T
Аннотация
OBJECTIVE: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery.
DESIGN: Single-health system, multihospital retrospective cohort study.
SETTING: 5 hospitals within the University of Pennsylvania Health System.
PATIENTS: Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic.
MEASUREMENTS: The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions.
RESULTS: Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change.
LIMITATIONS: Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications.
CONCLUSION: Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.