Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.
PLoS One. 2021 Mar 31;16(3):e0243291. doi: 10.1371/journal.pone.0243291. eCollection 2021.
Severe acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2.
This was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository.
Yale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas.
The study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020.
Primary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support.
Of the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection (median age 52.3 years) and 2154 (26.9%) of these had an associated admission (median age 66.2 years). Of admitted patients, 2152 (99.9%) had a discharge disposition at the end of the study period. Of these, 329 (15.3%) required invasive mechanical ventilation and 305 (14.2%) expired. Increased age and male sex were positively associated with admission and in-hospital mortality (median age 80.7 years), while comorbidities had a much weaker association with the risk of admission or mortality. Black race (OR 1.43, 95%CI 1.14-1.78) and Hispanic ethnicity (OR 1.81, 95%CI 1.50-2.18) were identified as risk factors for admission, but, among discharged patients, age-adjusted in-hospital mortality was not significantly different among racial and ethnic groups.
This observational study identified, among people testing positive for SARS-CoV-2 infection, older age and male sex as the most strongly associated risks for admission and in-hospital mortality in patients with SARS-CoV-2 infection. While minority racial and ethnic groups had increased burden of disease and risk of admission, age-adjusted in-hospital mortality for discharged patients was not significantly different among racial and ethnic groups. Ongoing studies will be needed to continue to evaluate these risks, particularly in the setting of evolving treatment guidelines.
严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）已在全球范围内感染了数百万人。我们的目标是确定与 SARS-CoV-2 患者住院和疾病严重程度相关的危险因素。
这是一项基于临床数据存储库的 7995 例 SARS-CoV-2 患者真实世界数据的观察性、回顾性研究。
耶鲁纽黑文健康系统（YNHH）是一家拥有 5 家医院的学术医疗系统，为城市和郊区的社区和教学设施提供多样化的患者群体。
本研究纳入了 2020 年 3 月 1 日至 4 月 30 日期间在 YNHH 进行 SARS-CoV-2 检测的成年患者。
主要结局是通过 RT-PCR 检测确定的 SARS-CoV-2 感染患者的住院和院内死亡率。我们还评估了与呼吸支持需求相关的特征。
在接受 SARS-CoV-2 检测的 28605 例患者中，7995 例（27.9%）感染了 SARS-CoV-2（中位年龄 52.3 岁），其中 2154 例（26.9%）需要住院治疗（中位年龄 66.2 岁）。在住院患者中，2152 例（99.9%）在研究结束时出院。其中，329 例（15.3%）需要有创机械通气，305 例（14.2%）死亡。年龄增长和男性与住院和院内死亡率呈正相关（中位年龄 80.7 岁），而合并症与住院或死亡风险的相关性较弱。黑人（OR 1.43，95%CI 1.14-1.78）和西班牙裔（OR 1.81，95%CI 1.50-2.18）被确定为住院的危险因素，但在出院患者中，年龄调整后的院内死亡率在不同种族和族裔群体之间没有显著差异。
本观察性研究确定，在 SARS-CoV-2 感染检测呈阳性的人群中，年龄较大和男性是 SARS-CoV-2 感染患者住院和院内死亡的最强相关风险因素。虽然少数族裔群体的疾病负担和住院风险较高，但出院患者的年龄调整后院内死亡率在不同种族和族裔群体之间没有显著差异。需要进行进一步的研究来继续评估这些风险，特别是在治疗指南不断演变的情况下。
