PDF(Pubmed)
Abstract：
BACKGROUND: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting.
OBJECTIVE: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel.
METHODS: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients.
RESULTS: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)-backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001).
CONCLUSIONS: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy.
OBJECTIVE: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel.
METHODS: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients.
RESULTS: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)-backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001).
CONCLUSIONS: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy.
摘要：
背景：COVID-19大流行导致大规模住院率激增。在没有足够医疗资源的情况下，住院人数的急剧增加可能会增加死亡率。在全国范围内，没有研究解决每日通气患者普查对大流行背景下死亡率的影响。
目的：本研究旨在确定每日通气患者普查是否影响以色列全国范围内的COVID-19死亡率。
方法：我们在全国范围内进行了一项队列研究，公共领域,从2020年3月11日至2021年2月11日，以色列数据库中基于人群的住院患者COVID-19数据。我们纳入了所有COVID-19住院患者，根据疾病控制和预防中心的分类，无论它们是否机械通气，都分为轻度至重度。结果指标是每日死亡率和以通气患者百分比表示的死亡率。
结果：在研究期间（从2020年3月11日到2021年2月11日的338天），715,743例患者感染并经临床证实患有COVID-19。其中,5577例（0.78%）患者死亡。总的来说,3398例患者因严重的COVID-19进行了通气。每日死亡率与通气患者的每日普查相关(R2=0.828,P<.001)。通气患者的每日死亡率百分比也与通气患者的每日普查相关（R2=0.365，P<.001）-向后多元回归分析表明，即使校正平均年龄或性别，这种正相关仍然非常显着。通气患者（R2=0.4328，P<.001）或其数量激增。总的来说,40％的死亡率变化是由通气患者每日普查的变化解释的。方差分析显示，每天不到50名通气患者，通气患者的每日死亡率略高于5%，它几乎翻了一番（10％），有50-149名患者；此外，在每天≥200名患者的所有类别中，在≥15%时增加了两倍多(P<.001)。
结论：每位通气患者的每日死亡率随着通气患者数量的增加而增加，表明医疗资源的饱和。政策制定者应该意识到，在没有足够资源的情况下扩大医疗服务可能会增加死亡率。政府应进行类似的分析，以提供系统饱和度的指标，尽管可能需要进一步验证这些结果以使用该指标来推动公共政策.
目的：本研究旨在确定每日通气患者普查是否影响以色列全国范围内的COVID-19死亡率。
方法：我们在全国范围内进行了一项队列研究，公共领域,从2020年3月11日至2021年2月11日，以色列数据库中基于人群的住院患者COVID-19数据。我们纳入了所有COVID-19住院患者，根据疾病控制和预防中心的分类，无论它们是否机械通气，都分为轻度至重度。结果指标是每日死亡率和以通气患者百分比表示的死亡率。
结果：在研究期间（从2020年3月11日到2021年2月11日的338天），715,743例患者感染并经临床证实患有COVID-19。其中,5577例（0.78%）患者死亡。总的来说,3398例患者因严重的COVID-19进行了通气。每日死亡率与通气患者的每日普查相关(R2=0.828,P<.001)。通气患者的每日死亡率百分比也与通气患者的每日普查相关（R2=0.365，P<.001）-向后多元回归分析表明，即使校正平均年龄或性别，这种正相关仍然非常显着。通气患者（R2=0.4328，P<.001）或其数量激增。总的来说,40％的死亡率变化是由通气患者每日普查的变化解释的。方差分析显示，每天不到50名通气患者，通气患者的每日死亡率略高于5%，它几乎翻了一番（10％），有50-149名患者；此外，在每天≥200名患者的所有类别中，在≥15%时增加了两倍多(P<.001)。
结论：每位通气患者的每日死亡率随着通气患者数量的增加而增加，表明医疗资源的饱和。政策制定者应该意识到，在没有足够资源的情况下扩大医疗服务可能会增加死亡率。政府应进行类似的分析，以提供系统饱和度的指标，尽管可能需要进一步验证这些结果以使用该指标来推动公共政策.
