ABSTRACT
Introduction : La prise en charge de l'épidémie de Covid-19 dans un service d'urgences (SU) requiert une évaluation de ses critères de gravité. La Covid-19 est évolutive et l'aggravation respiratoire détermine le pronostic. Notre objectif était de rechercher les facteurs prédictifs de gravité en fonction du délai d'initiation d'une oxygénothérapie dans une population française atteinte de Covid-19 au sein d'un SU. Matériels et méthode : L'étude observationnelle rétrospective aux Hôpitaux Universitaires de Strasbourg, durant la première vague de la pandémie, incluait les patients hospitalisés depuis le SU en 2020 pour infection au SARS-CoV-2. Elle évaluait les délais entre le début des symptômes (J0) et l'initiation d'une oxygénothérapie, et entre J0 et l'apparition des complications hospitalières. L'analyse multivariée recherchait les facteurs associés à l'oxygénothérapie précoce et à la mortalité intra-hospitalière. Résultats : 699 patients ont été inclus. L'oxygénothérapie était initiée le 7 ± 4e jour, la ventilation mécanique le 9 ± 4e jour. L'initiation précoce d'oxygénothérapie (avant le 6e jour) était significativement et indépendamment associée à l'immunosuppression, à l'âge ≥ 75 ans, à l'hypertension artérielle, et au sexe féminin. La mortalité intra-hospitalière était significativement et indépendamment associée à un âge ≥ 75 ans, une immunosuppression, une cardiopathie ischémique, et une oxygénothérapie précoce. Conclusion : Parmi les patients hospitalisés pour la Covid-19 durant la première vague, le jour moyen d'initiation d'oxygénothérapie était le septie jour. Une oxygénothérapie précoce, un âge ≥ 75 ans, une immunosuppression et une cardiopathie ischémique étaient associés à une forme grave de la Covid-19.Alternate abstract: Background: In emergency departments (EDs), the coronavirus disease 2019 (Covid-19) outbreak needs evaluation of severity criteria. Covid-19 is progressive and respiratory deterioration leads to the prognosis. The focus of the study was to find predictive factors of severity, according to the time period between disease onset and introduction of oxygen therapy, in a French population with Covid-19 within the ED. Methods: The observational retrospective study, led by the teaching hospitals of Strasbourg, during the first wave of the pandemic, included hospitalized patients from the ED in 2020, for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the time period between disease onset and introduction of oxygen therapy, and between disease onset and development of hospital complications. By multivariate analysis, we researched features associated with early oxygen therapy and in-hospital mortality. Findings: Of the 699 patients included, the mean period from disease onset to initiate oxygen was 7 ± 4 days, and to initiate mechanical ventilation was 9 ± 4 days. The early introduction of oxygen (i.e., before six days after disease onset) was significantly and independently related to immunosuppression, elderly patients (aged ≥75 years), hypertension, and female gender. In-hospital mortality was significantly and independently related to elderly patients (aged ≥75 years), immunosuppression, ischemic heart disease, and early oxygen therapy. Conclusion: Among hospitalized patients for Covid-19 during the first wave, the mean period to initiate oxygen was seven days. Early oxygen therapy, elderly age, immunosuppression, and ischemic heart disease are significantly related to severe Covid-19.
ABSTRACT
Background: In emergency departments (EDs), the coronavirus disease 2019 (Covid-19) outbreak needs evaluation of severity criteria. Covid-19 is progressive and respiratory deterioration leads to the prognosis. The focus of the study was to find predictive factors of severity, according to the time period between disease onset and introduction of oxygen therapy, in a French population with Covid-19 within the ED. Methods: The observational retrospective study, led by the teaching hospitals of Strasbourg, during the first wave of the pandemic, included hospitalized patients from the ED in 2020, for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the time period between disease onset and introduction of oxygen therapy, and between disease onset and development of hospital complications. By multivariate analysis, we researched features associated with early oxygen therapy and in-hospital mortality. Findings: Of the 699 patients included, the mean period from disease onset to initiate oxygen was 7 +/- 4 days, and to initiate mechanical ventilation was 9 +/- 4 days. The early introduction of oxygen (i.e., before six days after disease onset) was significantly and independently related to immunosuppression, elderly patients (aged >= 75 years), hypertension, and female gender. In-hospital mortality was significantly and independently related to elderly patients (aged >= 75 years), immunosuppression, ischemic heart disease, and early oxygen therapy. Conclusion: Among hospitalized patients for Covid-19 during the first wave, the mean period to initiate oxygen was seven days. Early oxygen therapy, elderly age, immuno-suppression, and ischemic heart disease are significantly related to severe Covid-19.