期刊
INFECTION
卷 49, 期 4, 页码 703-714出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s15010-021-01594-w
关键词
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Coronavirus disease 2019 (COVID-19); Viral concentration; COVID-19 nucleic acid testing; Respiratory distress syndrome; Mechanical ventilation; Artificial respiration; Prospective study; Symptom assessment
资金
- Berlin Institute of Health (BIH)
- German Federal Ministry of Education and Research NaFoUniMedCovid19NUM-NAPKON) [FKZ: 01KX2021, PROVIDFKZ 01KI20160A]
- Berlin Institute of Health, Charite-Universitatsmedizin Berlin
- German Ministry of Health (Konsiliarlabor fur Coronaviren)
- Projekt DEAL
Adequate patient allocation in healthcare systems is crucial for resource management. This study identified risk factors for invasive mechanical ventilation (IMV) in COVID-19 patients, showing shorter symptom duration and a history of hypertension as associated factors. Patients on IMV had different viral kinetics and longer hospitalization compared to non-IMV patients.
Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.
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