Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study.
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Murthy Srinivas, Archambault Patrick M, Atique Anika, Carrier François Martin, Cheng Matthew P, Codan Cassidy, Daneman Nick, Dechert William, Douglas Sarah, Fiest Kirsten M, Fowler Robert, Goco Geraldine, Gu Yusing, Guerguerian Anne-Marie, Hall Richard, Hsu Jimmy M, Joffe Ari, Jouvet Philippe, Kelly Laurel, Kho Michelle E, Kruisselbrink Rebecca J, Kumar Deepali, Kutsogiannis Demetrios James, Lamontagne François, Lee Todd C, Menon Kusum, O'Grady Heather, O'Hearn Katie, Ovakim Daniel H, Pharand Scott G, Pitre Tyler, Reel Riley, Reeve Brenda, Rewa Oleksa, Richardson David, Rishu Asgar, Sandhu Gyan, Sarfo-Mensah Shirley, Shadowitz Ellen, Sligl Wendy, Solomon Joshua, Stelfox Henry T, Swanson Ashleigh, Tessier-Grenier Hubert, Tsang Jennifer L Y, Wood Gordon, SPRINT-SARI Canada Investigators and the Canadian Critical Care Trials Group
Аннотация
METHODS: This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay.
RESULTS: Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09).
INTERPRETATION: Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.