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Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.
JAMA ( IF 51.273 ) Pub Date : 2020-04-06 , DOI: 10.1001/jama.2020.5394
Giacomo Grasselli,Alberto Zangrillo,Alberto Zanella,Massimo Antonelli,Luca Cabrini,Antonio Castelli,Danilo Cereda,Antonio Coluccello,Giuseppe Foti,Roberto Fumagalli,Giorgio Iotti,Nicola Latronico,Luca Lorini,Stefano Merler,Giuseppe Natalini,Alessandra Piatti,Marco Vito Ranieri,Anna Mara Scandroglio,Enrico Storti,Maurizio Cecconi,Antonio Pesenti,,Adriana Nailescu,Alberto Corona,Alberto Zangrillo,Alessandro Protti,Andrea Albertin,Andrea Forastieri Molinari,Andrea Lombardo,Angelo Pezzi,Annalisa Benini,Anna Mara Scandroglio,Annalisa Malara,Antonio Castelli,Antonio Coluccello,Antonio Micucci,Antonio Pesenti,Antonello Sala,Armando Alborghetti,Benvenuto Antonini,Carlo Capra,Carmine Troiano,Claudio Roscitano,Danilo Radrizzani,Davide Chiumello,Davide Coppini,Davide Guzzon,Elena Costantini,Elena Malpetti,Elena Zoia,Emanuele Catena,Emiliano Agosteo,Enrico Barbara,Enrico Beretta,Enrico Boselli,Enrico Storti,Fabiola Harizay,Federica Della Mura,Ferdinando Luca Lorini,Francesco Donato Sigurtà,Francesco Marino,Francesco Mojoli,Frank Rasulo,Giacomo Grasselli,Giampaolo Casella,Gianluca De Filippi,Gianpaolo Castelli,Giorgio Aldegheri,Giorgio Gallioli,Giorgio Lotti,Giovanni Albano,Giovanni Landoni,Giovanni Marino,Giovanni Vitale,Giovanni Battista Perego,Giulia Evasi,Giuseppe Citerio,Giuseppe Foti,Giuseppe Natalini,Guido Merli,Ilaria Sforzini,Leonardo Bianciardi,Livio Carnevale,Lorenzo Grazioli,Luca Cabrini,Luca Guatteri,Luca Salvi,Marco Dei Poli,Marco Galletti,Marco Gemma,Marco Ranucci,Mario Riccio,Massimo Borelli,Massimo Zambon,Matteo Subert,Maurizio Cecconi,Maurizio Giovanni Mazzoni,Maurizio Raimondi,Mauro Panigada,Mirko Belliato,Nicola Bronzini,Nicola Latronico,Nicola Petrucci,Nicolangela Belgiorno,Paola Tagliabue,Paolo Cortellazzi,Paolo Gnesin,Paolo Grosso,Paolo Gritti,Paolo Perazzo,Paolo Severgnini,Patrizia Ruggeri,Pietro Sebastiano,Remo Daniel Covello,Raquel Fernandez-Olmos,Roberto Fumagalli,Roberto Keim,Roberto Rona,Roberto Valsecchi,Sergio Cattaneo,Sergio Colombo,Silvia Cirri,Stefano Bonazzi,Stefano Greco,Stefano Muttini,Thomas Langer,Valentina Alaimo,Uberto Viola

Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001). Conclusions and Relevance In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.
更新日期:2020-04-06

 

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