Increased national critical care demands were associated with a higher mortality of intubated COVID-19 patients in Japan: a retrospective observational study.

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE Journal of Intensive Care Pub Date : 2024-11-05 DOI:10.1186/s40560-024-00758-8
Kazuya Kikutani, Mitsuaki Nishikimi, Ryo Emoto, Shigeyuki Matsui, Hiroyuki Ohbe, Takayuki Ogura, Satoru Hashimoto, Shigeki Kushimoto, Shinhiro Takeda, Shinichiro Ohshimo, Nobuaki Shime
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Abstract

Background: There was no study to investigate the association between the national surge of Coronavirus disease 2019 (COVID-19) patients and the mortality of mechanically ventilated COVID-19 patients. The aim of this study was to assess the association between mortality in mechanically ventilated COVID-19 patients and two distinct national COVID-19 surge indices: (1) the daily number of newly confirmed COVID-19 cases, representing overall medical demands and (2) the total number of critically ill COVID-19 patients, reflecting critical care demands.

Methods: We analyzed the patient data registered in a national database of mechanically ventilated COVID-19 patients between February 6, 2020, and May 16, 2023, combined with the data officially published by the Japanese government. Multivariable logistic regression analysis was performed to evaluate the association of these two indices with COVID-19 mortality. A generalized linear mixed effect model was used to examine the relationships between the variation in the impact of critical care demands across hospitals and the variation in baseline risk across hospitals.

Results: The data of 8327 patients from 264 centers in Japan were analyzed. The overall mortality rate was 24% (1990/8327). The critical care demands, but not overall medical demands, were independently associated with the mortality (OR, 1.11; 95% CI 1.07-1.16; p < 0.001). This effect of critical care demands on the mortality was more pronounced in hospitals with higher baseline risk (r = 0.67).

Conclusions: The national critical care demands were independently associated with the mortality of COVID-19 patients requiring mechanical ventilation. This effect was more pronounced in hospitals with higher baseline risk.

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日本全国重症监护需求的增加与 COVID-19 插管患者死亡率升高有关:一项回顾性观察研究。
背景:目前还没有研究调查全国冠状病毒病2019(COVID-19)患者激增与机械通气的COVID-19患者死亡率之间的关系。本研究旨在评估机械通气的COVID-19患者死亡率与两个不同的全国COVID-19激增指数之间的关联:(1)代表总体医疗需求的每日新确诊COVID-19病例数;(2)反映重症护理需求的COVID-19重症患者总数:我们分析了 2020 年 2 月 6 日至 2023 年 5 月 16 日期间全国机械通气 COVID-19 患者数据库中登记的患者数据,以及日本政府正式公布的数据。为了评估这两个指数与 COVID-19 死亡率的关系,我们进行了多变量逻辑回归分析。采用广义线性混合效应模型研究了各医院重症监护需求影响的差异与各医院基线风险差异之间的关系:结果:分析了来自日本 264 个中心的 8327 名患者的数据。总死亡率为 24%(1990/8327)。重症监护需求(而非总体医疗需求)与死亡率有独立关联(OR,1.11;95% CI 1.07-1.16;P 结论:重症监护需求(而非总体医疗需求)与死亡率有独立关联(OR,1.11;95% CI 1.07-1.16;P):全国重症监护需求与需要机械通气的 COVID-19 患者的死亡率密切相关。这种影响在基线风险较高的医院中更为明显。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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