Comorbid burden at ICU admission in COVID-19 compared to sepsis and acute respiratory distress syndrome.

IF 1.9 4区医学 Q2 ANESTHESIOLOGY Acta Anaesthesiologica Scandinavica Pub Date : 2024-08-26 DOI:10.1111/aas.14514

Björn Ahlström, Robert Frithiof, Ing-Marie Larsson, Gunnar Strandberg, Miklos Lipcsey, Michael Hultström

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Abstract

Background: Comorbidities are similarly associated with short-term mortality for COVID-19, acute respiratory distress syndrome (ARDS) and sepsis in intensive care unit (ICU) patients, but their adjusted frequencies at admission are unknown. Thus, we aimed to evaluate the adjusted distribution, reported as odds ratios, of known risk factors (i.e., age, sex and comorbidities) for ICU admission between COVID-19, sepsis and ARDS patients in this nationwide registry-based study.

Methods: In this cohort study, we included adult patients admitted to Swedish ICUs with COVID-19 (n = 7382) during the pandemic and compared them to patients admitted to ICU with sepsis (n = 22,354) or ARDS (n = 2776) during a pre-COVID-19 period. The main outcomes were the adjusted odds for comorbidities, sex, and age in multivariable logistic regression on diagnostic categories in patients admitted to ICU, COVID-19 or sepsis and COVID-19 or ARDS.

Results: We found that most comorbidities, as well as age, had a stronger association with sepsis admission than COVID-19 admission with the exception of male sex, type 2 diabetes mellitus, and asthma that were more strongly associated with COVID-19 admission, while no difference was seen for chronic renal failure and obesity. For COVID-19 and ARDS admission most risk factors were more strongly associated with ARDS admission except for male sex, type 2 diabetes mellitus, chronic renal failure, and obesity which were more strongly associated with COVID-19 admission, whereas hypertension, chronic obstructive pulmonary disease and asthma were not different.

Conclusions: Patients admitted to ICU with sepsis or ARDS carry a heavier burden of comorbidity and high age than patients admitted with COVID-19. This is likely caused by a combination of: (1) respiratory failure in COVID-19 being less dependent on comorbidities than in other forms of ARDS, and the cause of critical illness in other infections causing sepsis and (2) COVID-19 patients being deferred admission in situations where patients with the other syndromes were admitted.

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COVID-19 与败血症和急性呼吸窘迫综合征相比，入住 ICU 时的合并症负担。

背景：在重症监护病房（ICU）患者中，合并症与 COVID-19、急性呼吸窘迫综合征（ARDS）和败血症的短期死亡率具有相似的相关性，但其入院时的调整频率尚不清楚。因此，在这项基于全国登记的研究中，我们旨在评估 COVID-19、脓毒症和 ARDS 患者入住 ICU 时已知风险因素（即年龄、性别和合并症）的调整分布（以几率比形式报告）：在这项队列研究中，我们纳入了在流感大流行期间入住瑞典 ICU 的 COVID-19 成年患者（n = 7382），并将他们与在 COVID-19 之前入住 ICU 的败血症患者（n = 22354）或 ARDS 患者（n = 2776）进行了比较。主要结果是在多变量逻辑回归中对入住 ICU、COVID-19 或败血症以及 COVID-19 或 ARDS 患者的诊断类别进行合并症、性别和年龄的调整几率：我们发现，大多数合并症以及年龄与脓毒症入院的相关性都高于 COVID-19 入院的相关性，但男性、2 型糖尿病和哮喘与 COVID-19 入院的相关性更高，而慢性肾功能衰竭和肥胖则没有差异。就COVID-19和ARDS入院而言，除男性、2型糖尿病、慢性肾功能衰竭和肥胖与COVID-19入院关系更密切外，大多数风险因素与ARDS入院关系更密切，而高血压、慢性阻塞性肺病和哮喘则没有差异：结论：与 COVID-19 患者相比，因脓毒症或 ARDS 而入住重症监护室的患者合并症更多，年龄更大。这可能是以下因素共同作用的结果(1)与其他形式的 ARDS 相比，COVID-19 患者的呼吸衰竭对合并症的依赖性较低，而其他感染导致的败血症则是危重病的病因；(2)COVID-19 患者在其他综合征患者入院的情况下被推迟入院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Anaesthesiologica Scandinavica 医学-麻醉学

CiteScore

4.30

自引率

9.50%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.