Lazar Neto Felippe, Salzstein Guilherme A, Cortez André L, Bastos Thaís L, Baptista Fabíola V D, Moreira Joanne A, Lauterbach Gerhard P, de Oliveira Julio Cesar, de Assis Fábio C, Aguiar Marília R A, de Deus Aline A, Dias Marcos Felipe D S, Sousa Felipe C B, Duailibi Daniel F, Kondo Rodrigo H, de Moraes Augusto César F, Martins Milton A
Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil. Electronic address: https://twitter.com/.
Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil.
Int J Infect Dis. 2021 Apr;105:723-729. doi: 10.1016/j.ijid.2021.03.013. Epub 2021 Mar 9.
This study aimed to compare differences in mortality risk factors between admission and follow-up incorporated models.
A retrospective cohort study of 524 patients with confirmed COVID-19 infection admitted to a tertiary medical center in São Paulo, Brazil from 13 March to 30 April 2020. Data were collected on admission, and the third, eighth and fourteenth days of hospitalization. The hazard ratio (HR) was calculated and 28-day in-hospital mortality risk factors were compared between admission and follow-up models using a time-dependent Cox regression model.
Of 524 patients, 50.4% needed mechanical ventilation. The 28-day mortality rate was 32.8%. Compared with follow-up, admission models under-estimated the mortality HR for peripheral oxygen saturation <92% (1.21 versus 2.09), heart rate >100 bpm (1.19 versus 2.04), respiratory rate >24/min (1.01 versus 1.82) and mechanical ventilation (1.92 versus 12.93). Low oxygen saturation, higher oxygen support and more biomarkers-including lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea remained associated with mortality after adjustment for clinical factors at follow-up compared with only urea and oxygen support at admission.
The inclusion of follow-up measurements changed mortality hazards of clinical signs and biomarkers. Low oxygen saturation, higher oxygen support, lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea could help with prognosis of patients during follow-up.
本研究旨在比较入院模型和随访合并模型在死亡风险因素方面的差异。
对2020年3月13日至4月30日入住巴西圣保罗一家三级医疗中心的524例确诊新型冠状病毒肺炎感染患者进行回顾性队列研究。在入院时以及住院的第三天、第八天和第十四天收集数据。计算风险比（HR），并使用时间依赖性Cox回归模型比较入院模型和随访模型之间的28天院内死亡风险因素。
524例患者中，50.4%需要机械通气。28天死亡率为32.8%。与随访相比，入院模型低估了外周血氧饱和度<92%（1.21对2.09）、心率>100次/分钟（1.19对2.04）、呼吸频率>24次/分钟（1.01对1.82）和机械通气（1.92对12.93）的死亡HR。与入院时仅尿素和氧疗支持相比，随访时调整临床因素后，低血氧饱和度、更高的氧疗支持以及更多生物标志物（包括乳酸脱氢酶、C反应蛋白、中性粒细胞与淋巴细胞比值和尿素）仍与死亡相关。
纳入随访测量改变了临床体征和生物标志物的死亡风险。低血氧饱和度、更高的氧疗支持、乳酸脱氢酶、C反应蛋白、中性粒细胞与淋巴细胞比值和尿素有助于随访期间患者的预后评估。
