PDF(Pubmed)
Abstract：
UNASSIGNED: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.
UNASSIGNED: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.
UNASSIGNED: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).
UNASSIGNED: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves.
UNASSIGNED: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.
UNASSIGNED: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.
UNASSIGNED: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).
UNASSIGNED: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves.
UNASSIGNED: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.
摘要：
■COVID-19在身体上引起复杂的痛苦，心理,社会领域和姑息治疗（PC）有可能显着减轻这种痛苦。
■为了描述具有PC适应症的COVID-19患者的临床特征和结果，与没有适应症的患者相比，在不同的大流行浪潮中。
■这个回顾性多中心观察队列包括来自40家医院的患者，从2020年3月到2022年8月被录取。在医疗记录中有描述的姑息治疗（PC）指征的患者被纳入姑息治疗组（PCG）。而在医疗记录中没有此类适应症的患者被分配到非姑息治疗组(NPCG).
■在21,158名患者中，只有6.7%的人在其医疗记录中登记了PC适应症.PCG年龄较大，合并症的频率更高，表现出更高的脆弱，临床并发症和死亡率较高(81.4%vs.17.7%,p<0.001)，与NPCG相比。关于人工生命支持，PCG的透析频率更高(20.4%vs.10.1%,p<0.001)，有创机械通气（48.2%vs.26.0%,p<0.001）和重症监护病房（53.6%vs.35.4%,p<0.001)。这些差异在所有三个波中都是一致的。
■接受PC治疗的患者比例较低。PCG患者更脆弱，有更多的临床并发症，死亡率更高。与我们的期望相反,他们在所有三个浪潮中都获得了更多的人工生命支持。一起来看,这些发现表明，有关PC适应症的决定为时已晚，在生命终结和治疗失败的背景下。
■为了描述具有PC适应症的COVID-19患者的临床特征和结果，与没有适应症的患者相比，在不同的大流行浪潮中。
■这个回顾性多中心观察队列包括来自40家医院的患者，从2020年3月到2022年8月被录取。在医疗记录中有描述的姑息治疗（PC）指征的患者被纳入姑息治疗组（PCG）。而在医疗记录中没有此类适应症的患者被分配到非姑息治疗组(NPCG).
■在21,158名患者中，只有6.7%的人在其医疗记录中登记了PC适应症.PCG年龄较大，合并症的频率更高，表现出更高的脆弱，临床并发症和死亡率较高(81.4%vs.17.7%,p<0.001)，与NPCG相比。关于人工生命支持，PCG的透析频率更高(20.4%vs.10.1%,p<0.001)，有创机械通气（48.2%vs.26.0%,p<0.001）和重症监护病房（53.6%vs.35.4%,p<0.001)。这些差异在所有三个波中都是一致的。
■接受PC治疗的患者比例较低。PCG患者更脆弱，有更多的临床并发症，死亡率更高。与我们的期望相反,他们在所有三个浪潮中都获得了更多的人工生命支持。一起来看,这些发现表明，有关PC适应症的决定为时已晚，在生命终结和治疗失败的背景下。
