Background

The high transmission and fatality rates of coronavirus disease 2019 (COVID-19) strain intensive care resources and affect the treatment and prognosis of critically ill patients without COVID-19. Therefore, this study evaluated the differences in characteristics, clinical course, and prognosis of critically ill medical patients without COVID-19 before and during the COVID-19 pandemic.

Methods

This retrospective cohort study included patients from three university-affiliated tertiary hospitals. Demographic data and data on the severity, clinical course, and prognosis of medical patients without COVID-19 admitted to the intensive care unit (ICU) via the emergency room (ER) before (from January 1 to May 31, 2019) and during (from January 1 to May 31, 2021) the COVID-19 pandemic were obtained from electronic medical records. Propensity score matching was performed to compare hospital mortality between patients before and during the pandemic.

Results

This study enrolled 1161 patients (619 before and 542 during the pandemic). During the COVID-19 pandemic, the Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment (SOFA) scores, assessed upon ER and ICU admission, were significantly higher than those before the pandemic (p < 0.05). The lengths of stay in the ER, ICU, and hospital were also longer (p < 0.05). Finally, the hospital mortality rates were higher during the pandemic than before (215 [39.7%] vs. 176 [28.4%], p < 0.001). However, in the propensity score-matched patients, hospital mortality did not differ between the groups (p = 0.138). The COVID-19 pandemic did not increase the risk of hospital mortality (odds ratio [OR] 1.405, 95% confidence interval [CI], 0.937–2.107, p = 0.100). SAPS 3, SOFA score, and do-not-resuscitate orders increased the risk of in-hospital mortality in the multivariate logistic regression model.

Conclusions

In propensity score-matched patients with similarly severe conditions, hospital mortality before and during the COVID-19 pandemic did not differ significantly. However, hospital mortality was higher during the COVID-19 pandemic in unmatched patients in more severe conditions. These findings imply collateral damage to non-COVID-19 patients due to shortages in medical resources during the COVID-19 pandemic. Thus, strategic management of medical resources is required to avoid these consequences.

中文翻译：

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在 COVID-19 大流行之前和期间比较没有 COVID-19 的重症患者的临床特征和住院死亡率：一项多中心、回顾性、倾向评分匹配研究

背景

2019 年冠状病毒病 (COVID-19) 的高传播率和死亡率使重症监护资源紧张，并影响没有 COVID-19 的危重患者的治疗和预后。因此，本研究评估了在 COVID-19 大流行之前和期间没有 COVID-19 的危重患者在特征、临床过程和预后方面的差异。

方法

这项回顾性队列研究包括来自三所大学附属三级医院的患者。在（2019 年 1 月 1 日至 5 月 31 日）之前（2019 年 1 月 1 日至 5 月 31 日）和期间（从 2021 年 1 月 1 日到 5 月 31 日）COVID-19 大流行是从电子病历中获得的。进行倾向评分匹配以比较大流行之前和期间患者之间的住院死亡率。

结果

这项研究招募了 1161 名患者（大流行之前的 619 名和大流行期间的 542 名）。在 COVID-19 大流行期间，急诊室和重症监护室入院时评估的简化急性生理学评分 (SAPS) 3 和序贯器官衰竭评估 (SOFA) 评分显着高于大流行前 ( p  < 0.05)。急诊室、重症监护室和医院的住院时间也更长（p  < 0.05）。最后，大流行期间的医院死亡率比以前更高（215 [39.7%] vs. 176 [28.4%]，p  < 0.001）。然而，在倾向评分匹配的患者中，两组的住院死亡率没有差异（p = 0.138）。COVID-19 大流行并未增加住院死亡率的风险（优势比 [OR] 1.405，95% 置信区间 [CI]，0.937–2.107，p  = 0.100）。在多元逻辑回归模型中，SAPS 3、SOFA 评分和不复苏指令增加了住院死亡率的风险。

结论

在病情相似的倾向评分匹配的患者中，COVID-19 大流行之前和期间的住院死亡率没有显着差异。然而，在 COVID-19 大流行期间，病情更严重的无与伦比的患者的住院死亡率更高。这些发现意味着由于 COVID-19 大流行期间医疗资源短缺，对非 COVID-19 患者造成了附带损害。因此，需要对医疗资源进行战略管理以避免这些后果。