James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Am J Transplant. 2020 Nov;20(11):3061-3071. doi: 10.1111/ajt.16280. Epub 2020 Sep 15.
National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.
国家关于危重症 2019 冠状病毒病（COVID-19）实体器官移植（SOT）患者的患者特征、治疗和结局的数据有限。我们分析了一项多中心队列研究的数据，该研究纳入了 2020 年 3 月 4 日至 5 月 8 日期间美国 68 家医院重症监护病房（ICU）收治的实验室确诊 COVID-19 的成人患者。在 4153 例患者中，我们创建了一个倾向评分匹配队列，包含 386 例患者，包括 98 例 SOT 患者和 288 例非 SOT 患者。我们使用二项广义线性模型（对数二项式模型）来研究 SOT 状态与死亡和其他临床结局的关联。在 386 例患者中，中位年龄为 60 岁，72%为男性，41%为黑人。ICU 入院后 28 天内的死亡率在 SOT 和非 SOT 患者中相似（分别为 40%和 43%，相对风险[RR] 0.92；95%置信区间[CI]：0.70-1.22）。其他结局和器官支持的需求，包括接受机械通气、急性呼吸窘迫综合征的发生和血管加压药的使用，两组之间也相似。SOT 患者发生需要肾脏替代治疗的急性肾损伤的风险略高于非 SOT 患者（37% vs. 27%；RR[95%CI]：1.34[0.97-1.85]）。COVID-19 危重症 SOT 和非 SOT 患者的死亡率和器官支持需求相似。
