■我们之前的分析表明,希腊接受COVID-19插管的患者的院内死亡率如何受到患者负担和地区差异的不利影响。
■我们旨在更新此分析,以包括2021-2022年期间影响希腊的大型Delta和Omicron波,同时还考虑了疫苗接种对住院死亡率的影响。
分析了2020年9月1日至2022年4月4日在希腊插管的所有COVID-19患者的匿名监测数据,并随访至2022年5月17日。时间分裂泊松回归用于估计死亡的危险,作为固定和时变协变量的函数:希腊的COVID-19插管患者的每日总数,年龄,性别,COVID-19疫苗接种状况,医院区域(阿提卡,塞萨洛尼基,或希腊其他地区),在重症监护室,以及2021年9月1日起的指标。
■共分析了14011例COVID-19插管患者,其中10466人(74.7%)死亡。400-499名插管患者的死亡率明显更高,调整后的危险比(HR)为1.22(95%CI1.09-1.38),≥800名患者的负荷逐渐上升至1.48(95%CI1.31-1.69)。远离阿提卡地区的住院也与死亡率增加独立相关(塞萨洛尼基:HR1.22,95%CI1.13-1.32;希腊其他地区:HR1.64,95%CI1.54-1.75),2021年9月1日以后住院(HR1.21,95%CI1.09-1.36)。COVID-19疫苗接种没有影响这些已经重症患者的死亡率,其中大多数(11,944/14,011,85.2%)未接种疫苗。
我们的研究结果证实,COVID-19重症患者的院内死亡率受到高患者负担和地区差异的不利影响,并指出2021年9月1日之后进一步显著恶化,特别是远离阿提卡和塞萨洛尼基。这凸显了紧急加强希腊卫生保健服务的必要性,确保为所有人提供公平和高质量的护理。
UNASSIGNED: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities.
UNASSIGNED: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality.
UNASSIGNED: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021.
UNASSIGNED: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95% CI 1.13-1.32; rest of Greece: HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated.
UNASSIGNED: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all.