Semantic Scholar Open Access 2020 1362 sitasi

Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy.

Giacomo Grasselli M. Greco A. Zanella Giovanni Albano M. Antonelli +143 lainnya

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Abstrak

Importance Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU). Objective To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy. Design, Setting, and Participants This retrospective, observational cohort study included 3988 consecutive critically ill patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di Ricovero e Cura a Carattere Scientifico] Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20 to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swabs. Follow-up was completed on May 30, 2020. Exposures Baseline characteristics, comorbidities, long-term medications, and ventilatory support at ICU admission. Main Outcomes and Measures Time to death in days from ICU admission to hospital discharge. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression. Results Of the 3988 patients included in this cohort study, the median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI, 78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least 1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%) required invasive mechanical ventilation (IMV). The median follow-up was 44 (95% CI, 40-47; IQR, 11-69; range, 0-100) days; median time from symptoms onset to ICU admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12 (95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11; IQR, 6-17) days. Cumulative observation time was 164 305 patient-days. Hospital and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000 patients-days, respectively. In the subgroup of the first 1715 patients, as of May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%) died in the hospital. Independent risk factors associated with mortality included older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95% CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI, 1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06) or low Pao2:Fio2 ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19), hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR, 1.18; 95% CI, 1.01-1.39). No medication was independently associated with mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42; angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29). Conclusions and Relevance In this retrospective cohort study of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients required IMV. The mortality rate and absolute mortality were high.

Topik & Kata Kunci

Medicine

Penulis (148)

Giacomo Grasselli

M. Greco

A. Zanella

Giovanni Albano

M. Antonelli

G. Bellani

E. Bonanomi

Luca Cabrini

E. Carlesso

G. Castelli

Sergio Cattaneo

D. Cereda

Sergio Colombo

A. Coluccello

Giuseppe Crescini

A. Forastieri Molinari

Giuseppe Foti

Roberto Fumagalli

G. Iotti

Thomas Langer

Nicola Latronico

F. Lorini

Francesco Mojoli

Giuseppe Natalini

C. Pessina

V. Ranieri

R. Rech

L. Scudeller

Antonio Rosano

E. Storti

B. Thompson

M. Tirani

P. Villani

A. Pesenti

M. Cecconi

Emiliano Agosteo

Giovanni Albano

A. Albertin

A. Alborghetti

G. Aldegheri

B. Antonini

E. Barbara

G. Bardelloni

Sabrina Basilico

Nicolangela Belgiorno

G. Bellani

E. Beretta

Angela Berselli

Leonardo Bianciardi

E. Bonanomi

S. Bonazzi

M. Borelli

N. Bottino

Nicola Bronzini

Serena Brusatori

Luca Cabrini

C. Capra

L. Carnevale

G. Castelli

E. Catena

Sergio Cattaneo

M. Cecconi

S. Celotti

S. Cerutti

D. Chiumello

S. Cirri

G. Citerio

Sergio Colombo

A. Coluccello

David Coppini

A. Corona

P. Cortellazzi

E. Costantini

R. D. Covello

Giuseppe Crescini

G. De Filippi

Marco Dei Poli

Paolo Dughi

Fulvia Fieni

Gaetano Florio

A. Forastieri Molinari

Giuseppe Foti

Roberto Fumagalli

M. Galletti

G. Gallioli

Hedwige Gay

Marco Gemma

P. Gnesin

Giacomo Grasselli

Stefano Greco

M. Greco

P. Grosso

Luca Guatteri

D. Guzzon

G. Iotti

R. Keim

Thomas Langer

Nicola Latronico

Andrea Lombardo

F. Lorini

F. Mamprin

G. Marino

F. Marino

G. Merli

Antonio Micucci

C. Militano

Francesco Mojoli

G. Monti

Stefano Muttini

S. Nadalin

Giuseppe Natalini

P. Perazzo

G. Perego

L. Perotti

A. Pesenti

C. Pessina

N. Petrucci

A. Pezzi

Simone Piva

G. Portella

A. Protti

M. Racagni

D. Radrizzani

M. Raimondi

M. Ranucci

R. Rech

M. Riccio

Antonio Rosano

Patrizia Ruggeri

G. Sala

Luca Salvi

Pietro Sebastiano

P. Severgnini

Donato Sigurtà

N. Stocchetti

E. Storti

M. Subert

M. Tavola

S. Todaro

F. Torriglia

D. Tubiolo

Roberto Valsecchi

P. Villani

Uberto Viola

G. Vitale

Massimo Zambon

A. Zanella

E. Zoia

Format Sitasi

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Grasselli, G., Greco, M., Zanella, A., Albano, G., Antonelli, M., Bellani, G. et al. (2020). Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy.. https://doi.org/10.1001/jamainternmed.2020.3539

@article{grasselli2020, author = {Giacomo Grasselli and M. Greco and A. Zanella and Giovanni Albano and M. Antonelli and G. Bellani and E. Bonanomi and Luca Cabrini and E. Carlesso and G. Castelli and Sergio Cattaneo and D. Cereda and Sergio Colombo and A. Coluccello and Giuseppe Crescini and A. Forastieri Molinari and Giuseppe Foti and Roberto Fumagalli and G. Iotti and Thomas Langer and Nicola Latronico and F. Lorini and Francesco Mojoli and Giuseppe Natalini and C. Pessina and V. Ranieri and R. Rech and L. Scudeller and Antonio Rosano and E. Storti and B. Thompson and M. Tirani and P. Villani and A. Pesenti and M. Cecconi and Emiliano Agosteo and Giovanni Albano and A. Albertin and A. Alborghetti and G. Aldegheri and B. Antonini and E. Barbara and G. Bardelloni and Sabrina Basilico and Nicolangela Belgiorno and G. Bellani and E. Beretta and Angela Berselli and Leonardo Bianciardi and E. Bonanomi and S. Bonazzi and M. Borelli and N. Bottino and Nicola Bronzini and Serena Brusatori and Luca Cabrini and C. Capra and L. Carnevale and G. Castelli and E. Catena and Sergio Cattaneo and M. Cecconi and S. Celotti and S. Cerutti and D. Chiumello and S. Cirri and G. Citerio and Sergio Colombo and A. Coluccello and David Coppini and A. Corona and P. Cortellazzi and E. Costantini and R. D. Covello and Giuseppe Crescini and G. De Filippi and Marco Dei Poli and Paolo Dughi and Fulvia Fieni and Gaetano Florio and A. Forastieri Molinari and Giuseppe Foti and Roberto Fumagalli and M. Galletti and G. Gallioli and Hedwige Gay and Marco Gemma and P. Gnesin and Giacomo Grasselli and Stefano Greco and M. Greco and P. Grosso and Luca Guatteri and D. Guzzon and G. Iotti and R. Keim and Thomas Langer and Nicola Latronico and Andrea Lombardo and F. Lorini and F. Mamprin and G. Marino and F. Marino and G. Merli and Antonio Micucci and C. Militano and Francesco Mojoli and G. Monti and Stefano Muttini and S. Nadalin and Giuseppe Natalini and P. Perazzo and G. Perego and L. Perotti and A. Pesenti and C. Pessina and N. Petrucci and A. Pezzi and Simone Piva and G. Portella and A. Protti and M. Racagni and D. Radrizzani and M. Raimondi and M. Ranucci and R. Rech and M. Riccio and Antonio Rosano and Patrizia Ruggeri and G. Sala and Luca Salvi and Pietro Sebastiano and P. Severgnini and Donato Sigurtà and N. Stocchetti and E. Storti and M. Subert and M. Tavola and S. Todaro and F. Torriglia and D. Tubiolo and Roberto Valsecchi and P. Villani and Uberto Viola and G. Vitale and Massimo Zambon and A. Zanella and E. Zoia}, title = {Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy.}, year = {2020}, journal = {Semantic Scholar}, doi = {10.1001/jamainternmed.2020.3539}, url = {https://www.semanticscholar.org/paper/e16b60d811ef5cc8bfdb308389fe57642f662a10}, }

Akses Cepat

Lihat di Sumber doi.org/10.1001/jamainternmed.2020.3539

Informasi Jurnal

Tahun Terbit: 2020
Bahasa: en
Total Sitasi: 1362×
Sumber Database: Semantic Scholar
DOI: 10.1001/jamainternmed.2020.3539
Akses: Open Access ✓