Healthcare strain and intensive care during the COVID-19 outbreak in the Lombardy region: a retrospective observational study on 43,538 hospitalized patients
Healthcare strain and intensive care during the COVID-19 outbreak in the Lombardy region: a retrospective observational study on 43,538 hospitalized patients
ABSTRACT BackgroundDuring the spring of 2020, the SARS-CoV-2 epidemic has caused significant resource strain in hospitals of Lombardy, Italy, with the demand for intensive care beds for COVID-19 patients exceeding the overall pre-crisis capacity. In this study, we evaluate the effect of healthcare strain on ICU admission and survival. MethodsWe used data on 43,538 patients admitted to a hospital in the region between February 20 and July 12, 2020, of which 3,993 (9.2%) were admitted to an ICU. We applied logistic regression to model the probability of being admitted to an ICU and the probability of survival among ICU patients. Negative binomial regressions were used to model the time between hospital and ICU admission and the length of stay in ICU. ResultsDuring the period of highest hospital strain (March 16 – April 22), individuals older than 70 years had a significantly lower probability of being admitted to an ICU and significantly longer times between hospital and ICU admission, indicating elective admission due to constrained resources. Healthcare strain did not have a clear effect on mortality, with the overall proportion of deaths declining from 52.1% (95%CI 49.8-54.5) for ICU patients admitted to the hospital before March 16, to 43.4% (95%CI 41.5-45.6) between March 16 and April 22, to 27.6% (95%CI 20.0-35.2) after April 22. ConclusionsThese data demonstrate and quantify the adoption of elective admission to ICUs during the peak phase of the SARS-CoV-2 epidemic in Lombardy. However, we show that for patients admitted to ICUs, clinical outcomes progressively improved despite the saturation of healthcare resources.
Gramegna Maria、Ajelli Marco、Guzzetta Giorgio、Tirani Marcello、Cereda Danilo、Barone Antonio、Preziosi Giuseppe、Arduini Fabio、Della Valle Petra Giulia、Zanella Alberto、del Castillo Gabriele、Trentini Filippo、Andreassi Aida、Poletti Piero、Castrofino Ambra、Marziano Valentina、Piatti Alessandra、Grasselli Giacomo、Melegaro Alessia、Piccarreta Raffaella、Merler Stefano、Grosso Francesca
Directorate General for HealthDepartment of Epidemiology and Biostatistics, Indiana University School of Public Health||Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern UniversityBruno Kessler FoundationDirectorate General for Health||Health Protection Agency of PaviaDirectorate General for HealthRegional Agency for Innovation and ProcurementRegional Agency for Innovation and ProcurementRegional Agency for Innovation and ProcurementDepartment of Public Health, Experimental and Forensic Medicine, University of PaviaDepartment of Pathophysiology and Transplantation, University of MilanDepartment of Public Health, University of MilanBruno Kessler FoundationDirectorate General for HealthBruno Kessler FoundationDepartment of Public Health, University of MilanBruno Kessler FoundationDirectorate General for HealthDepartment of Pathophysiology and Transplantation, University of Milan||Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca?ˉ Granda Ospedale Maggiore PoliclinicoBocconi University, Dondena Centre for Research on Social Dynamics and Public Policy||Department of Social and Political Sciences, Bocconi UniversityBocconi University, Dondena Centre for Research on Social Dynamics and Public Policy||Department of Decision Sciences, Bocconi UniversityBruno Kessler FoundationDepartment of Public Health, University of Milan
医学研究方法临床医学内科学
COVID-19 hospitalizationintensive care managementhealthcare strainlength of stay in ICUrisk factors
Gramegna Maria,Ajelli Marco,Guzzetta Giorgio,Tirani Marcello,Cereda Danilo,Barone Antonio,Preziosi Giuseppe,Arduini Fabio,Della Valle Petra Giulia,Zanella Alberto,del Castillo Gabriele,Trentini Filippo,Andreassi Aida,Poletti Piero,Castrofino Ambra,Marziano Valentina,Piatti Alessandra,Grasselli Giacomo,Melegaro Alessia,Piccarreta Raffaella,Merler Stefano,Grosso Francesca.Healthcare strain and intensive care during the COVID-19 outbreak in the Lombardy region: a retrospective observational study on 43,538 hospitalized patients[EB/OL].(2025-03-28)[2025-04-24].https://www.medrxiv.org/content/10.1101/2020.11.06.20149690.点此复制
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