机械通风患者的COVID-19相关的肺:一个前性的,多中心的英国研究
William Hurt1,2,3, Jonathan Youngs4,2, Jonathan Ball5
1Institute of Infection and Immunity, St George's University of London, London, UK whurt@sgul.ac.uk.
Thorax
|September 1, 2023
概括
在英国的一项研究中,COVID-19相关的肺炎 (CAPA) 发生在10.9%的机械通风患者中. 风险因素包括类固醇使用,IL-6抑制剂和COPD,但CAPA没有显著影响死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 菌类学 菌类学是指菌类学.
背景情况:
- 侵袭性肺阿斯伯吉洛症是严重的COVID-19的严重并发症.
- 据报道,COVID-19相关肺阿斯伯吉洛症 (CAPA) 的发病率和死亡率呈现区域差异.
- 了解CAPA在英国的发病率,风险因素和结果至关重要.
研究的目的:
- 为了确定CAPA在机械通风COVID-19患者的未来,多中心英国队列中的发生率.
- 确定与CAPA发展相关的风险因素.
- 评估CAPA对该患者群体死亡率的影响.
主要方法:
- 在2020年3月至2021年3月期间,在5个英国重症监护室 (ICU) 招募了266名COVID-19感染机械通风成年人的潜在队列.
- 根据欧洲医学真菌学联合会和国际人类和动物真菌学学会的标准诊断出CAPA.
- 用呼吸道和血清样本进行真菌诊断;统计分析包括多变量逻辑回归和生存分析.
主要成果:
- 可能的CAPA发生率为10.9% (29/266),可能的CAPA发生率为5.2% (14/266);没有发现已证明的CAPA病例.
- 与可能的CAPA相关的因素包括累积的皮质类固醇剂量,接收互白素-6 (IL-6) 抑制剂,以及先前存在的慢性阻塞性肺病 (COPD).
- 虽然可能的CAPA与较高的原始死亡率相关 (55%与46%相比),但经过对混因素进行调整后,这种关联在统计学上并没有保持显著.
结论:
- 在这个英国队列中,可能的CAPA与皮质类固醇使用,IL-6抑制剂和COPD有关.
- 在对预后变量进行调整后,CAPA没有证明对90天死亡率有重大影响.
- 可能需要进一步的研究来澄清CAPA对结果和最佳治疗策略的确切影响.
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