第一个和随后的SARS-CoV-2波之间的结果比较 - 一个系统的审查和元分析
Tulio Caldonazo1, Ricardo E Treml2, Felipe S L Vianna3,4
1Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany.
Multidisciplinary respiratory medicine
|December 29, 2023
概括
与后一波相比,第一波COVID-19患者在重症监护室 (ICU) 停留时间,急性功能衰竭和体外膜氧化 (ECMO) 植入率较高. 死亡率在各个波段保持相似.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 流行病学 流行病学
背景情况:
- 由于未知的特定治疗方法,早期的COVID-19流行病反应依赖于支持性护理.
- 随后的流行病浪潮受益于诊断,抗病毒和疫苗方面的进步.
- 这项研究比较了SARS-CoV-2大流行初期和后期阶段的临床结果.
研究的目的:
- 进行元分析和系统审查,比较COVID-19流行病的第一波和随后一波之间的临床终点.
- 评估死亡率,资源利用率和并发症的差异.
- 评估不断变化的医学知识和干预措施随着时间的推移的影响.
主要方法:
- 对25项涉及126,153名患者的研究进行了系统审查和元分析.
- 主要结局:住院死亡率.
- 二次结局包括ICU死亡率,ICU停留时间 (LOS),急性功能衰竭,ECMO植入,机械通风持续时间,医院LOS,血栓塞栓,心肌炎和呼吸机相关肺炎.
主要成果:
- 在住院死亡率上没有显著差异 (OR=0.94,p=0.35).
- 在ICU LOS (SMD=0.23,p<0.01),急性功能衰竭 (OR=1.71,p<0.01) 和ECMO植入 (OR=1.64,p=0.03) 的第一波组中观察到更高的比率.
- 在其他二次终点中没有显著差异.
结论:
- 与随后的波相比,COVID-19第一个波的患者在ICU停留时间增加,急性功能衰竭和ECMO使用增加.
- 在第一波和后一波之间,住院和ICU的死亡率没有显著差异.
- 这些发现突出了随着时间的推移在管理严重的COVID-19并发症方面的改进,尽管总体死亡率相似.
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