社会人口统计学变量作为新冠病毒感染不良结局的预测因素：爱尔兰一家医院的经验
Sociodemographic variables as predictors of adverse outcome in SARS-CoV-2 infection: an Irish hospital experience.
作者信息
Farrell Richard J, O'Regan Rhea, O'Neill Eoghan, Bowens Grainne, Maclellan Anne, Gileece Anne, Bradley Maeve, Smyth Claire, Kelly Orlaith, Hall Barry, Cormican Liam, Faul John, Wanic Krzysztof, McDermott John, Sreenan Seamus, Tun Tommy Kyaw, Duffy Trevor, Bhatti Azhar Iqbal, Donohoe Orla, Leen Eamon, Collins Niamh, McGeary Shane, Cody Catriona, Dolan Eamon, Burke Conor
机构信息
Departments of Medicine, Connolly Hospital, Ireland and Royal College of Surgeons Ireland, Dublin, Ireland.
Departments of Microbiology, Connolly Hospital, Ireland and Royal College of Surgeons Ireland, Dublin, Ireland.
出版信息
Ir J Med Sci. 2021 Aug;190(3):893-903. doi: 10.1007/s11845-020-02407-z. Epub 2020 Nov 3.
INTRODUCTION
Our hospital found itself at the epicentre of the Irish COVID-19 pandemic. We describe the organisational challenges faced in managing the surge and identified risk factors for mortality and ICU admission among hospitalised SARS-CoV-2-infected patients.
METHODS
All hospitalised SARS-CoV-2 patients diagnosed between March 13 and May 1, 2020, were included. Demographic, referral, deprivation, ethnicity and clinical data were recorded. Multivariable regression, including age-adjusted hazard ratios (HR (95% CI), was used to explore risk factors associated with adverse outcomes.
RESULTS
Of 257 inpatients, 174 were discharged (68%) and 39 died (15%) in hospital. Two hundred three (79%) patients presented from the community, 34 (13%) from care homes and 20 (8%) were existing inpatients. Forty-five percent of community patients were of a non-Irish White or Black, Asian or minority ethnic (BAME) population, including 34 Roma (13%) compared to 3% of care home and 5% of existing inpatients, (p < 0.001). Twenty-two patients were healthcare workers (9%). Of 31 patients (12%) requiring ICU admission, 18 were discharged (58%) and 7 died (23%). Being overweight/obese HR (95% CI) 3.09 (1.32, 7.23), p = 0.009; a care home resident 2.68 (1.24, 5.6), p = 0.012; socioeconomically deprived 1.05 (1.01, 1.09), p = 0.012; and older 1.04 (1.01, 1.06), p = 0.002 were significantly associated with death. Non-Irish White or BAME were not significantly associated with death 1.31 (0.28, 6.22), p = 0.63 but were significantly associated with ICU admission 4.38 (1.38, 14.2), p = 0.014 as was being overweight/obese 2.37 (1.37, 6.83), p = 0.01.
CONCLUSION
The COVID-19 pandemic posed unprecedented organisational issues for our hospital resulting in the greatest surge in ICU capacity above baseline of any Irish hospital. Being overweight/obese, a care home resident, socioeconomically deprived and older were significantly associated with death, while ethnicity and being overweight/obese were significantly associated with ICU admission.
引言
我们医院处于爱尔兰新冠疫情的中心。我们描述了在应对激增情况时面临的组织挑战，并确定了住院的感染新冠病毒患者的死亡和入住重症监护病房的风险因素。
方法
纳入2020年3月13日至5月1日期间确诊的所有住院新冠患者。记录人口统计学、转诊、贫困程度、种族和临床数据。采用多变量回归，包括年龄调整风险比（HR（95%置信区间））来探索与不良结局相关的风险因素。
结果
257名住院患者中，174人出院（68%），39人在医院死亡（15%）。203名（79%）患者来自社区，34名（13%）来自养老院，20名（8%）是现有住院患者。社区患者中有45%是非爱尔兰白人或黑人、亚洲或少数族裔（BAME）人群，其中包括34名罗姆人（13%），而养老院患者中这一比例为3%，现有住院患者中为5%，（p < 0.001）。22名患者是医护人员（9%）。在31名（12%）需要入住重症监护病房的患者中，18人出院（58%），7人死亡（23%）。超重/肥胖HR（95%置信区间）3.09（1.32，7.23），p = 0.009；养老院居民2.68（1.24，5.6），p = 0.012；社会经济贫困1.05（1.01，1.09），p = 0.012；以及年龄较大1.04（1.01，1.06），p = 0.002与死亡显著相关。非爱尔兰白人或BAME与死亡无显著关联1.31（0.28，6.22），p = 0.63，但与入住重症监护病房显著相关4.38（1.38，14.2），p = 应为0.014，超重/肥胖也是如此2.37（1.37，6.83），p = 0.01。
结论
新冠疫情给我们医院带来了前所未有的组织问题，导致重症监护病房容量比爱尔兰任何一家医院的基线水平都有最大幅度的激增。超重/肥胖、养老院居民、社会经济贫困和年龄较大与死亡显著相关，而种族和超重/肥胖与入住重症监护病房显著相关。
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