Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States

被引：88

作者：

Anesi, George L. ^{[1
,2
]}

Jablonski, Juliane ^{[1
,3
]}

Harhay, Michael O. ^{[1
,4
]}

Atkins, Joshua H. ^{[1
,5
]}

Bajaj, Jasmeet ^{[1
,6
]}

Baston, Cameron ^{[1
,7
]}

Brennan, Patrick J. ^{[1
,8
]}

Candeloro, Christina L. ^{[1
,9
]}

Catalano, Lauren M. ^{[1
,10
]}

Cereda, Maurizio F. ^{[1
,5
]}

Chandler, John M. ^{[1
,11
]}

Christie, Jason D. ^{[1
,12
]}

Collins, Tara ^{[1
,13
]}

Courtright, Katherine R. ^{[1
,4
]}

Fuchs, Barry D. ^{[1
,9
]}

Gordon, Emily ^{[1
,5
]}

Greenwood, John C. ^{[1
,14
]}

Gudowski, Steven ^{[1
,15
]}

Hanish, Asaf ^{[1
,16
]}

Hanson, C. William, III ^{[1
,5
]}

Heuer, Monica ^{[1
,17
]}

Kinniry, Paul ^{[1
,10
]}

Kornfield, Zev Noah ^{[1
,5
]}

Kruse, Gregory B. ^{[1
,8
]}

Lane-Fall, Meghan ^{[1
,5
]}

Martin, Niels D. ^{[1
,18
]}

Mikkelsen, Mark E. ^{[1
,19
]}

Negoianu, Dan ^{[1
,20
]}

Pascual, Jose L. ^{[1
,13
]}

Patel, Maulik B. ^{[1
,21
]}

Pugliese, Steven C. ^{[1
,22
]}

Qasim, Zaffer A. ^{[1
,23
]}

Reilly, John P. ^{[1
,7
]}

Salmon, John ^{[1
,24
]}

Schweickert, William D. ^{[1
,7
]}

Scott, Michael J. ^{[1
,17
]}

Shashaty, Michael G. S. ^{[25
]}

Sicoutris, Corinna P. ^{[26
]}

Wang, John K. ^{[27
]}

Wang, Wei ^{[28
]}

Wani, Arshad A. ^{[29
]}

Anderson, Brian J. ^{[7
]}

Gutsche, Jacob T. ^{[30
]}

机构：

[1] Univ Penn Hlth Syst, Philadelphia, PA USA

[2] Div Pulm Allergy & Crit Care, 3400 Spruce St,5037 Gates Bldg, Philadelphia, PA 19104 USA

[3] Hosp Univ Penn, 3400 Spruce St,5 Rhoads Bldg, Philadelphia, PA 19104 USA

[4] 423 Guardian Dr,304 Blockley Hall, Philadelphia, PA 19104 USA

[5] Hosp Univ Penn, 3400 Spruce St,6 Dulles Bldg, Philadelphia, PA 19104 USA

[6] 3546 Route 27, Kendall Pk, NJ 08824 USA

[7] Hosp Univ Penn, 3400 Spruce St,5 Gates Bldg, Philadelphia, PA 19104 USA

[8] Perelman Ctr Adv Med, 3400 Civ Ctr Blvd,Suite 5A, Philadelphia, PA 19104 USA

[9] Hosp Univ Penn, 3400 Spruce St,9 Founders Bldg, Philadelphia, PA 19104 USA

[10] Penn Med Washington Sq,800 Walnut St,9th Floor, Philadelphia, PA 19107 USA

[11] Hosp Univ Penn, 3400 Spruce St,3 Gates Bldg, Philadelphia, PA 19104 USA

[12] Hosp Univ Penn, 3400 Spruce St,8 Maloney Bldg, Philadelphia, PA 19104 USA

[13] Penn Presbyterian Med Ctr, 51 North 39th St,Med Off Bldg,Suite 120, Philadelphia, PA 19104 USA

[14] Hosp Univ Penn, Dept Emergency Med, 3400 Spruce St, Philadelphia, PA 19104 USA

[15] Hosp Univ Penn, Resp Care Serv, 3400 Spruce St, Philadelphia, PA 19104 USA

[16] Penn Med Corp Informat Serv, 3930 Chestnut St, Philadelphia, PA 19104 USA

[17] Hosp Univ Penn, 3400 Spruce St,5 Founders Bldg, Philadelphia, PA 19104 USA

[18] Penn Med Univ City, 3737 Market St,4th Floor, Philadelphia, PA 19104 USA

[19] Hosp Univ Penn, 3400 Spruce St,5042 Gates Bldg, Philadelphia, PA 19104 USA

[20] Hosp Univ Penn, 3400 Spruce St,1 Founders Bldg, Philadelphia, PA 19104 USA

[21] 540 North Duke St,Suite 244, Lancaster, PA 17602 USA

[22] Hosp Univ Penn, 3400 Spruce St,8 Gates Bldg, Philadelphia, PA 19104 USA

[23] Penn Presbyterian Med Ctr, 51 North 39th St,Myrin Bldg, Philadelphia, PA 19104 USA

[24] 3600 Civ Ctr Blvd,7th Floor,7W-101-30, Philadelphia, PA 19104 USA

[25] Hosp Univ Penn, 3400 Spruce St,5039 Gates Bldg, Philadelphia, PA 19104 USA

[26] Hosp Univ Penn, 3400 Spruce St,1 Dulles Bldg, Philadelphia, PA 19104 USA

[27] Chester Cty Hosp, 701 East Marshall St, W Chester, PA 19380 USA

[28] 423 Guardian Dr,3 Blockley Hall, Philadelphia, PA 19104 USA

[29] Penn Med Univ City, 3737 Market St,10th Floor, Philadelphia, PA 19104 USA

[30] Penn Presbyterian Med Ctr, 51 North 39th St,223 Wright Saunders, Philadelphia, PA 19104 USA

来源：

ANNALS OF INTERNAL MEDICINE | 2021年 / 174卷 / 05期

基金：

美国医疗保健研究与质量局; 美国国家卫生研究院;

关键词：

INTENSIVE-CARE-UNIT; SEPSIS; SURVIVORS;

D O I：

10.7326/M20-5327

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. 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.

引用

页码：613 / +

页数：11

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