SARS-CoV-2パンデミックにおけるUKSHリューベックでの経験
Matthias Mezger1,2, Sebastian Wolfrum3, Toni Pätz4,5
1Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Kardiologie, Angiologie, internistische Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. Matthias.Mezger@UKSH.de.
Background And Objectives:
Transfer of critically ill, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients to a tertiary care center in combination with mortality prediction using the Simplified Acute Physiology Score (SAPS II) score has not been investigated in detail so far, in Germany.
Materials And Methods:
A retrospective analysis of SARS-CoV-2 patients receiving intensive care unit (ICU) treatment at a tertiary care center between 1 March 2020 and 31 December 2021 was performed. Patients directly admitted through the emergency room (PA) and patients admitted later-on from hospitals with lower level of care (SA) were compared.
Results:
In all, 165 SARS-CoV-2 patients with a SAPS II score received intensive care during the period described. SA patients were significantly younger (SA 62.2 years [IQR 51.9-72.4] vs. PA 70.8 years [IQR 58.3-79.9], p = 0.002), were ventilated longer (SA 16.5 days [IQR 7-31] vs. PA 7 days [IQR 4-11], p < 0.001) but had the same hospital mortality (SA 53.3% vs. PA 45.7%, p = 0.41). Predicted mortality through SAPS II score underestimated true mortality in both patient collectives (SA 15.2% [IQR 7.9-26.6] vs. PA 19.6% [IQR 9.2-34.7], p = 0.17).
Conclusion:
The prognostic value of SAPS II is limited for patients suffering from SARS-CoV‑2. Interhospital transfer of critically ill patients seems reasonable since mortality is not different between patients primarily admitted to a tertiary center and patients admitted later-on during disease course.
