Declining Intensive Care Unit Mortality of COVID-19: A Multi-Center Study.

Autor:	Roomi S; Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA., Shah SO; Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA., Ullah W; Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA., Abedin SU; Department of Medicine, Abington Hospital, Jefferson Health, Philadelphia, PA, USA., Butler K; Department of Surgery, Division of Surgical Critical Care, Abington Hospital, Jefferson Health, Philadelphia, PA, USA., Schiers K; Department of Medicine, Jefferson Health New Jersey, Washington Township, NJ, USA., Kohl B; Department of Anesthesiology, Aria-Jefferson Health, Philadelphia, PA, USA., Yoo E; Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA., Vibbert M; Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA., Jallo J; Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical medicine research [J Clin Med Res] 2021 Mar; Vol. 13 (3), pp. 184-190. Date of Electronic Publication: 2021 Mar 19.
DOI:	10.14740/jocmr4452
Abstrakt:	Background: Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods: This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. Chi-square (χ 2 ) test, Fisher exact test, Cochran-Mantel-Haenszel method, multinomial logistic regression models, independent sample t -test, Mann-Whitney U test and one-way analysis of variance (ANOVA) were used. Results: A total of 1,204 patients were included. Overall mortality was 39%. Mortality declined significantly from 46% in March to 14% in August 2020 (P < 0.05). The most common underlying comorbidities were hypertension (60.2%), diabetes mellitus (44.7%), dyslipidemia (31.6%) and congestive heart failure (14.7%). Hydroxychloroquine (HCQ) use was more commonly associated with the patients who died, while the use of remdesivir, tocilizumab, steroids and duration of these medications were not significantly different. Peak values of ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer levels were significantly higher in patients who died (P < 0.05). The mean hospital LOS was significantly longer in the patients who survived compared to the patients who died (18 vs. 12, P < 0.05). Conclusions: The mortality of patients admitted to our ICU system significantly decreased over time. Factors that may have contributed to this may be the result of a better understanding of COVID-19 pathophysiology and treatments. Further research is needed to elucidate the factors contributing to a reduction in the mortality rate for this patient population. Competing Interests: There are no conflicts of interest disclosed by any of the authors associated with this manuscript. (Copyright 2021, Roomi et al.)
Databáze:	MEDLINE
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