CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
These authors contributed equally.
Euro Surveill. 2020 Dec;25(48). doi: 10.2807/1560-7917.ES.2020.25.48.2000895.
BackgroundIn March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization.AimOur objective was to identify risk factors predictive of severe disease and death in France.MethodsIn this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation.ResultsAmong 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20-100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0-1.2), male sex (OR: 2.1; 95% CrI: 1.5-2.8), BMI of 25-29.9 kg/m2 (OR: 1.8; 95% CrI: 1.2-2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5-3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8-3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1-3.4), male sex (OR: 1.7; 95% CrI: 1.1-2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6-7.7), diabetes (OR: 1.7; 95% CrI: 1.0-2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3-3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2-3.4) and inflammatory parameters.ConclusionsOverweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.
背景
2020 年 3 月，世界卫生组织宣布 COVID-19 疫情为大流行。
目的
本研究旨在确定法国 COVID-19 患者发生重症和死亡的相关预测因素。
方法
这是一项前瞻性队列研究，纳入了 2020 年 3 月在法国斯特拉斯堡和米卢斯医院住院的≥18 岁确诊 COVID-19 患者。我们分别比较了发生重症（入住重症监护病房（ICU）或死亡）和死亡患者与未发生重症或死亡患者的差异，时间为入院后第 7 天。
结果
在 1045 例患者中，424 例（41%）发生重症，其中 335 例（32%）入住 ICU，115 例（11%）死亡。平均年龄为 66 岁（范围：20-100 岁），612 例（59%）为男性。几乎 75%（n=897）有体重指数（BMI）数据的患者 BMI≥25kg/m2（n=661）。与重症相关的独立危险因素包括高龄（每增加 10 岁，OR：1.1；95%CI：1.0-1.2）、男性（OR：2.1；95%CI：1.5-2.8）、BMI 为 25-29.9kg/m2（OR：1.8；95%CI：1.2-2.7）或≥30kg/m2（OR：2.2；95%CI：1.5-3.3）、呼吸困难（OR：2.5；95%CI：1.8-3.4）和炎症参数（升高的 C 反应蛋白和中性粒细胞计数，低淋巴细胞计数）。与死亡相关的危险因素包括高龄（每增加 10 岁，OR：2.7；95%CI：2.1-3.4）、男性（OR：1.7；95%CI：1.1-2.7）、免疫抑制（OR：3.8；95%CI：1.6-7.7）、糖尿病（OR：1.7；95%CI：1.0-2.7）、慢性肾脏病（OR：2.3；95%CI：1.3-3.9）、呼吸困难（OR：2.1；95%CI：1.2-3.4）和炎症参数。
结论
超重、肥胖、高龄、男性、合并症、呼吸困难和炎症是住院患者发生重症 COVID-19 或死亡的危险因素。在常规临床实践中识别这些特征可能有助于改善 COVID-19 管理。
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