慢性呼吸系统疾病与 COVID-19 结局的关系：一项全国范围回顾性队列研究的 39420 例病例分析。

Chronic Respiratory Diseases and the Outcomes of COVID-19: A Nationwide Retrospective Cohort Study of 39,420 Cases.

机构信息

State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Department of Thoracic Oncology and Surgery, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

出版信息

J Allergy Clin Immunol Pract. 2021 Jul;9(7):2645-2655.e14. doi: 10.1016/j.jaip.2021.02.041. Epub 2021 Mar 6.

DOI:10.1016/j.jaip.2021.02.041

PMID:33684635

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7935669/

Abstract

BACKGROUND

Chronic respiratory diseases (CRD) are common among patients with coronavirus disease 2019 (COVID-19).

OBJECTIVES

We sought to determine the association between CRD (including disease overlap) and the clinical outcomes of COVID-19.

METHODS

Data of diagnoses, comorbidities, medications, laboratory results, and clinical outcomes were extracted from the national COVID-19 reporting system. CRD was diagnosed based on International Classification of Diseases-10 codes. The primary endpoint was the composite outcome of needing invasive ventilation, admission to intensive care unit, or death within 30 days after hospitalization. The secondary endpoint was death within 30 days after hospitalization.

RESULTS

We included 39,420 laboratory-confirmed patients from the electronic medical records as of May 6, 2020. Any CRD and CRD overlap was present in 2.8% and 0.2% of patients, respectively. Chronic obstructive pulmonary disease (COPD) was most common (56.6%), followed by bronchiectasis (27.9%) and asthma (21.7%). COPD-bronchiectasis overlap was the most common combination (50.7%), followed by COPD-asthma (36.2%) and asthma-bronchiectasis overlap (15.9%). After adjustment for age, sex, and other systemic comorbidities, patients with COPD (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.44-2.03) and asthma (OR: 1.45, 95% CI: 1.05-1.98), but not bronchiectasis, were more likely to reach to the composite endpoint compared with those without at day 30 after hospitalization. Patients with CRD were not associated with a greater likelihood of dying from COVID-19 compared with those without. Patients with CRD overlap did not have a greater risk of reaching the composite endpoint compared with those without.

CONCLUSION

CRD was associated with the risk of reaching the composite endpoint, but not death, of COVID-19.

摘要

背景

慢性呼吸道疾病（CRD）在 2019 冠状病毒病（COVID-19）患者中较为常见。

目的

我们旨在确定 CRD（包括疾病重叠）与 COVID-19 临床结局之间的关系。

方法

从国家 COVID-19 报告系统中提取诊断、合并症、药物、实验室结果和临床结局数据。CRD 是根据国际疾病分类第 10 版（ICD-10）代码诊断的。主要终点是住院 30 天内需要有创通气、入住重症监护病房或死亡的复合结局。次要终点是住院 30 天内死亡。

结果

截至 2020 年 5 月 6 日，我们从电子病历中纳入了 39420 例经实验室确诊的患者。分别有 2.8%和 0.2%的患者存在任何 CRD 和 CRD 重叠。最常见的是慢性阻塞性肺疾病（COPD）（56.6%），其次是支气管扩张症（27.9%）和哮喘（21.7%）。COPD-支气管扩张症重叠是最常见的组合（50.7%），其次是 COPD-哮喘（36.2%）和哮喘-支气管扩张症重叠（15.9%）。在调整年龄、性别和其他系统性合并症后，与无 COPD 的患者相比，有 COPD（比值比[OR]：1.71，95%置信区间[CI]：1.44-2.03）和哮喘（OR：1.45，95% CI：1.05-1.98）的患者在住院后 30 天更有可能达到复合终点。与无 CRD 的患者相比，有 CRD 的患者死于 COVID-19 的可能性并没有增加。CRD 重叠的患者与无 CRD 重叠的患者相比，达到复合终点的风险没有增加。