慢性阻塞性肺疾病患者新型冠状病毒肺炎感染的临床特征：一项多中心、回顾性、观察性研究
Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study.
作者信息
Wu Fan, Zhou Yumin, Wang Zhongfang, Xie Min, Shi Zhe, Tang Zhiqiang, Li Xiaohe, Li Xiaochen, Lei Chunliang, Li Yimin, Ni Zhengyi, Hu Yu, Liu Xiaoqing, Yin Wenguang, Cheng Linling, Ye Feng, Peng Jieqi, Huang Lingmei, Tian Jia, Zhang Lingjuan, Mo Xiaoneng, Zhang Ying, Hu Ke, Jiang Yongliang, Guan Weijie, Xiang Jie, Liu Yingxia, Peng Yixiang, Wei Li, Hu Yahua, Peng Peng, Wang Jianming, Liu Jiyang, Huang Wei, Chen Ruchong, Zhao Jianping, Li Shiyue, Zhang Nuofu, Zhao Jincun, Zhong Nanshan, Ran Pixin
机构信息
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
J Thorac Dis. 2020 May;12(5):1811-1823. doi: 10.21037/jtd-20-1914.
BACKGROUND
Coronavirus disease 2019 (COVID-19) has been a global pandemic disease, with more than 4 million cases and nearly 300,000 deaths. Little is known about COVID-19 in patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the influence of preexisting COPD on the progress and outcomes of COVID-19.
METHODS
This was a multicenter, retrospective, observational study. We enrolled 1,048 patients aged 40 years and above, including 50 patients with COPD and 998 patients without COPD, and with COVID-19 confirmed via high-throughput sequencing or real-time reverse transcription-polymerase chain reaction, between December 11, 2019 and February 20, 2020. We collected data of demographics, pathologic test results, radiologic imaging, and treatments. The primary outcomes were composite endpoints determined by admission to an intensive care unit, the use of mechanical ventilation, or death.
RESULTS
Compared with patients who had COVID-19 but not COPD, those with COPD had higher rates of fatigue (56.0% 40.2%), dyspnea (66.0% 26.3%), diarrhea (16.0% 3.6%), and unconsciousness (8.0% 1.7%) and a significantly higher proportion of increased activated partial thromboplastin time (23.5% 5.2%) and D-dimer (65.9% 29.3%), as well as ground-glass opacities (77.6% 60.3%), local patchy shadowing (61.2% 41.4%), and interstitial abnormalities (51.0% 19.8%) on chest computed tomography. Patients with COPD were more likely to develop bacterial or fungal coinfection (20.0% 5.9%), acute respiratory distress syndrome (ARDS) (20.0% 7.3%), septic shock (14.0% 2.3%), or acute renal failure (12.0% 1.3%). Patients with COPD and COVID-19 had a higher risk of reaching the composite endpoints [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.40-3.38; P=0.001] or death (HR: 2.28, 95% CI: 1.15-4.51; P=0.019), after adjustment.
CONCLUSIONS
In this study, patients with COPD who developed COVID-19 showed a higher risk of admission to the intensive care unit, mechanical ventilation, or death.
背景
2019年冠状病毒病（COVID-19）已成为全球大流行病，病例超过400万例，死亡近30万例。关于慢性阻塞性肺疾病（COPD）患者的COVID-19情况，人们了解甚少。我们旨在评估预先存在的COPD对COVID-19进展和结局的影响。
方法
这是一项多中心、回顾性、观察性研究。我们纳入了1048名40岁及以上的患者，其中包括50名COPD患者和998名无COPD患者，这些患者在2019年12月11日至2020年2月20日期间经高通量测序或实时逆转录-聚合酶链反应确诊为COVID-19。我们收集了人口统计学、病理检查结果、放射影像学和治疗的数据。主要结局是由入住重症监护病房、使用机械通气或死亡确定的复合终点。
结果
与患有COVID-19但无COPD的患者相比，COPD患者疲劳（56.0%对40.2%）、呼吸困难（66.0%对26.3%）、腹泻（16.0%对3.6%）和意识丧失（8.0%对1.7%）的发生率更高，活化部分凝血活酶时间升高（23.5%对5.2%）和D-二聚体升高（65.9%对29.3%）的比例显著更高，以及胸部计算机断层扫描显示磨玻璃影（77.6%对60.3%）、局部斑片状阴影（61.2%对41.4%）和间质异常（51.0%对19.8%）。COPD患者更易发生细菌或真菌合并感染（20.0%对5.9%）、急性呼吸窘迫综合征（ARDS）（20.0%对7.3%）、感染性休克（14.0%对2.3%）或急性肾衰竭（12.0%对1.3%）。调整后，COPD合并COVID-19的患者达到复合终点[风险比（HR）：2.17，95%置信区间（CI）：1.40 - 3.38；P = 0.001]或死亡（HR：2.28，95%CI：1.15 - 4.51；P = 0.019）的风险更高。
结论
在本研究中，发生COVID-19的COPD患者入住重症监护病房、接受机械通气或死亡的风险更高。
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