Royal Surrey County Hospital, Guildford, UK.
Royal Surrey County Hospital, Guildford, UK and University of Surrey, Guildford, UK. Harry Knights and Nikhil Mayor contributed equally to this work.
Clin Med (Lond). 2020 Sep;20(5):e148-e153. doi: 10.7861/clinmed.2020-0303. Epub 2020 Jul 24.
This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers.
Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020.
108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 μmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19.
This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.
本回顾性队列研究旨在确定 2020 年 3 月在萨里郡的一家地区综合医院因 COVID-19 住院的每位患者的临床发现和结局，为英国第一波感染提供快照。这项研究首次深入了解脆弱性标志物对患者结局的影响，并提供了医护人员的感染率。
数据来自病历。结局指标为氧疗水平、出院和死亡。患者随访至 2020 年 4 月 21 日。
共纳入 108 例患者。34 例（31%）在医院死亡或出院接受姑息治疗。65 岁以上患者的病死率为 43%。最常见的合并症是高血压（49 例；45%）和糖尿病（25 例；23%）。死亡患者年龄较大（平均差异±SEM，13.76±3.12 岁；p<0.0001）， NEWS2 评分较高（中位数 6，IQR 2.5-7.5 vs 中位数 2，IQR 2-6），肾功能较差（中位数差异：尿素 2.7 mmol/L，p<0.01；肌酐 4 μmol/L，p<0.05；eGFR 14 mL/min，p<0.05）与幸存者相比。脆弱性标志物被确定为死亡的危险因素。65 岁以上死亡患者的临床虚弱量表（CFS）评分高于幸存者（中位数 5，IQR 4-6 vs 3.5，IQR 2-5；p<0.01）。死亡患者的肌钙蛋白和肌酸激酶水平高于恢复患者（p<0.0001）。淋巴细胞减少症很常见（中位数 0.8，IQR 0.6-1.2；p<0.005）。每例心力衰竭患者均死亡（8 例）。26 例（24%）接受持续气道正压通气（CPAP；中位数 3 天，IQR 2-7.3）治疗，9 例（8%）插管（中位数 14 天，IQR 7-21）。所有出院后死亡的患者（4 例；6%）均为养老院居民。699 名医院工作人员中，276 人 COVID-19 检测呈阳性。
本研究确定脆弱性较大的老年患者特别脆弱，并强化了不惜一切代价保护这一群体的政府政策。
