Purpose

To assess whether intensive care unit (ICU) outcomes for patients not affected by coronavirus disease 2019 (COVID-19) worsened during the COVID-19 pandemic.

Methods

Retrospective cohort study including prospectively collected information of patients admitted to 165 ICUs in a hospital network in Brazil between 2011 and 2020. Association between admission in 2020 and worse hospital outcomes was performed using different techniques, including assessment of changes in illness severity of admitted patients, a variable life-adjusted display of mortality during 2020, a multivariate mixed regression model with admission year as both fixed effect and random slope adjusted for SAPS 3 score, an analysis of trends in performance using standardized mortality ratio (SMR) and standardized resource use (SRU), and perturbation analysis.

Results

A total of 644,644 admissions were considered. After excluding readmissions and patients with COVID-19, 514,219 patients were available for analysis. Non-COVID-19 patients admitted in 2020 had slightly lower age and SAPS 3 score but a higher mortality (6.4%) when compared with previous years (2019: 5.6%; 2018: 6.1%). Variable-adjusted life display (VLAD) in 2020 increased but started to decrease as the number of COVID-19 cases increased; this trend reversed as number of COVID cases reduced but recurred on the second wave. After logistic regression, being admitted in 2020 was associated with higher mortality when compared to previous years from 2016 and 2019. Individual ICUs standardized mortality ratio also increased during 2020 (higher SMR) while resource use remained constant, suggesting worsening performance. A perturbation analysis further confirmed changes in ICU outcomes for non-COVID-19 patients.

Conclusion

Hospital outcomes of non-COVID-19 critically ill patients worsened during the pandemic in 2020, possibly resulting in an increased number of deaths in critically ill non-COVID patients.

中文翻译：

---

COVID-19 大流行与非 COVID-19 重症患者的短期结果的关联：巴西 ICU 的观察性队列研究

目的

评估未受 2019 年冠状病毒病 (COVID-19) 影响的患者的重症监护病房 (ICU) 结局是否在 COVID-19 大流行期间恶化。

方法

回顾性队列研究包括前瞻性收集 2011 年至 2020 年期间巴西一家医院网络中 165 个 ICU 住院患者的信息。使用不同的技术对 2020 年入院与更差的医院结果之间的关联进行了分析，包括评估入院患者疾病严重程度的变化， 2020 年死亡率的可变寿命调整显示，以入院年份作为固定效应和随机斜率的多元混合回归模型，根据 SAPS 3 分数调整，使用标准化死亡率（SMR）和标准化资源使用分析绩效趋势（ SRU）和扰动分析。

结果

总共考虑了 644,644 名录取。排除再入院和 COVID-19 患者后，有 514,219 名患者可供分析。与往年（2019 年：5.6%；2018 年：6.1%）相比，2020 年入院的非 COVID-19 患者的年龄和 SAPS 3 评分略低，但死亡率更高（6.4%）。2020 年的可变调整寿命显示 (VLAD) 有所增加，但随着 COVID-19 病例数的增加而开始下降；随着 COVID 病例数量的减少，这种趋势发生了逆转，但在第二波疫情中再次出现。经过逻辑回归后，与 2016 年和 2019 年的前几年相比，2020 年入院与更高的死亡率相关。2020 年个体 ICU 标准化死亡率也有所增加（更高的 SMR），而资源使用保持不变，表明表现恶化。

结论

在 2020 年大流行期间，非 COVID-19 重症患者的医院预后恶化，可能导致重症非 COVID 患者的死亡人数增加。