背景:多中心流行病学研究尚未确定与COVID-19患者死亡相关的器官功能障碍。在这项研究中,我们评估了与死亡的主要关联,伴随的器官功能障碍,以及COVID-19患者死亡中多器官功能衰竭的比例,以及有关器官支持的信息。
方法:我们使用日本多中心的COVID-19研究,通过组装真实世界数据(J-RECOVER)研究数据库进行了观察性队列研究。该数据库包括2020年1月1日至9月31日期间出院的患者数据,SARS-CoV-2检测结果为阳性,无论重症监护病房的入院情况如何。这些数据是从日本66家医院的诊断程序组合和电子病历中收集的。临床医生鉴定并记录了导致COVID-19死亡的器官。
结果:在研究期间,参加J-RECOVER研究的66家医院的4700名COVID-19患者出院;其中,来自47个死亡机构的272名患者(5.8%)被纳入本研究。呼吸系统功能障碍(87.1%)是与死亡的主要关联,其次是心血管(4.8%),中枢神经(2.9%),胃肠道(2.6%),肾功能不全(1.1%)。大多数死于COVID-19的患者(96.7%)有呼吸系统损害,约一半(48.9%)有多器官损伤。在与死亡的主要关联是呼吸功能障碍的患者中,120例(50.6%)接受了机械通气。
结论:这项研究表明,尽管在许多情况下,呼吸功能障碍是与死亡最常见的关联,多器官功能障碍与COVID-19导致的死亡相关。
BACKGROUND: The organ dysfunction that is associated with death in COVID-19 patients has not been determined in multicenter epidemiologic studies. In this
study, we evaluated the major association with death, concomitant organ dysfunction, and proportion of multiple organ failure in deaths in patients with COVID-19, along with information on organ support.
METHODS: We performed an observational cohort
study using the Japanese multicenter research of COVID-19 by assembling a real-world data (J-RECOVER)
study database. This database consists of data on patients discharged between January 1 and September 31, 2020, with positive SARS-CoV-2 test results, regardless of intensive care unit admission status. These data were collected from the Diagnosis Procedure Combination and electronic medical records of 66 hospitals in Japan. The clinician identified and recorded the organ responsible for the death of COVID-19.
RESULTS: During the research period, 4,700 patients with COVID-19 were discharged from 66 hospitals participating in the J-RECOVER
study; of which, 272 patients (5.8%) from 47 institutions who died were included in this
study. Respiratory system dysfunction (87.1%) was the leading association with death, followed by cardiovascular (4.8%), central nervous (2.9%), gastrointestinal (2.6%), and renal (1.1%) dysfunction. Most patients (96.7%) who died of COVID-19 had respiratory system damage, and about half (48.9%) had multi-organ damage. Of the patients whose main association with death was respiratory dysfunction, 120 (50.6%) received mechanical ventilation.
CONCLUSIONS: This study showed that although respiratory dysfunction was the most common association with death in many cases, multi-organ dysfunction was associated with death due to COVID-19.