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10.1001/jamainternmed.2020.3539

http://scihub22266oqcxt.onion/10.1001/jamainternmed.2020.3539
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32667669!7364371!32667669
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suck abstract from ncbi


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pmid32667669      JAMA+Intern+Med 2020 ; 180 (10): 1345-1355
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  • Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy #MMPMID32667669
  • Grasselli G; Greco M; Zanella A; Albano G; Antonelli M; Bellani G; Bonanomi E; Cabrini L; Carlesso E; Castelli G; Cattaneo S; Cereda D; Colombo S; Coluccello A; Crescini G; Forastieri Molinari A; Foti G; Fumagalli R; Iotti GA; Langer T; Latronico N; Lorini FL; Mojoli F; Natalini G; Pessina CM; Ranieri VM; Rech R; Scudeller L; Rosano A; Storti E; Thompson BT; Tirani M; Villani PG; Pesenti A; Cecconi M
  • JAMA Intern Med 2020[Oct]; 180 (10): 1345-1355 PMID32667669show ga
  • IMPORTANCE: Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU). OBJECTIVE: To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, observational cohort study included 3988 consecutive critically ill patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di Ricovero e Cura a Carattere Scientifico] Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20 to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swabs. Follow-up was completed on May 30, 2020. EXPOSURES: Baseline characteristics, comorbidities, long-term medications, and ventilatory support at ICU admission. MAIN OUTCOMES AND MEASURES: Time to death in days from ICU admission to hospital discharge. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression. RESULTS: Of the 3988 patients included in this cohort study, the median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI, 78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least 1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%) required invasive mechanical ventilation (IMV). The median follow-up was 44 (95% CI, 40-47; IQR, 11-69; range, 0-100) days; median time from symptoms onset to ICU admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12 (95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11; IQR, 6-17) days. Cumulative observation time was 164?305 patient-days. Hospital and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000 patients-days, respectively. In the subgroup of the first 1715 patients, as of May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%) died in the hospital. Independent risk factors associated with mortality included older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95% CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI, 1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06) or low Pao2:Fio2 ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19), hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR, 1.18; 95% CI, 1.01-1.39). No medication was independently associated with mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42; angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29). CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients required IMV. The mortality rate and absolute mortality were high.
  • |*Coronavirus Infections/diagnosis/mortality/therapy[MESH]
  • |*Critical Illness/mortality/therapy[MESH]
  • |*Pandemics[MESH]
  • |*Pneumonia, Viral/mortality/therapy[MESH]
  • |Betacoronavirus/isolation & purification[MESH]
  • |COVID-19[MESH]
  • |COVID-19 Testing[MESH]
  • |COVID-19 Vaccines[MESH]
  • |Clinical Laboratory Techniques/methods/statistics & numerical data[MESH]
  • |Female[MESH]
  • |Hospital Mortality[MESH]
  • |Hospitalization/*statistics & numerical data[MESH]
  • |Humans[MESH]
  • |Intensive Care Units/*statistics & numerical data[MESH]
  • |Italy/epidemiology[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Mortality[MESH]
  • |Respiration, Artificial/*statistics & numerical data[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Factors[MESH]


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