爱尔兰新冠肺炎患者的基础疾病以及住院、入住重症监护病房和死亡风险：一项全国性监测研究。
Underlying conditions and risk of hospitalisation, ICU admission and mortality among those with COVID-19 in Ireland: A national surveillance study.
作者信息
Bennett Kathleen E, Mullooly Maeve, O'Loughlin Mark, Fitzgerald Margaret, O'Donnell Joan, O'Connor Lois, Oza Ajay, Cuddihy John
机构信息
Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Data Science Centre, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin, Ireland.
出版信息
Lancet Reg Health Eur. 2021 Jun;5:100097. doi: 10.1016/j.lanepe.2021.100097. Epub 2021 Apr 15.
BACKGROUND
To date, over 2 million people worldwide have died with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To describe the experience in Ireland, this study examined associations between underlying conditions and the following outcomes: mortality, admission to hospital or admission to the intensive care unit (ICU) among those infected with COVID-19.
METHODS
This study used data from the Health Protection Surveillance Centre in Ireland and included confirmed cases of COVID-19 from the first wave of the pandemic between March and July 2020. Two cohorts were included: all cases (community and hospital) and hospital admissions only. For all cases, health outcome data included mortality and hospitalisation. For hospitalised cases, outcome data included mortality and ICU admission. Logistic regression was used to examine associations between underlying conditions and outcomes across both cohorts. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CIs).
FINDINGS
There were 19,789 cases included in analysis, which encompassed 1,476 (7.5%) deaths, 2,811 (14.2%) hospitalisations, and 438 (2.2%) ICU admissions of whom 90 (20.5%) died. Significantly higher risk of mortality, hospitalisation and ICU admission was associated with having chronic heart disease, a BMI ≥40kg/m and male sex. Additionally, diagnosis of a chronic neurological condition (OR 1.41; 95%CI:1.17, 1.69), chronic kidney disease (OR 1.74; 95%CI:1.35, 2.24) and cancer (OR 2.77; 95%CI:2.21, 3.47) were significantly associated with higher risk of mortality among all cases, with similar patterns of association observed for mortality among hospitalised cases.
INTERPRETATION
The identification of underlying conditions among COVID-19 cases may help identify those at highest risk of the worst health outcomes and inform preventive strategies to improve outcomes.
FUNDING
This study was supported by the Health Service Executive, Health Protection Surveillance Centre. KEB and MM are funded by the Health Research Board (RL-15-1579 and EIA-2019-012 respectively).
背景
截至目前，全球已有超过200万人死于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染。为描述爱尔兰的情况，本研究调查了基础疾病与以下结局之间的关联：2019冠状病毒病（COVID-19）感染者的死亡率、住院或重症监护病房（ICU）收治情况。
方法
本研究使用了爱尔兰卫生保护监测中心的数据，纳入了2020年3月至7月第一波疫情期间确诊的COVID-19病例。包括两个队列：所有病例（社区和医院）以及仅住院病例。对于所有病例，健康结局数据包括死亡率和住院情况。对于住院病例，结局数据包括死亡率和ICU收治情况。采用逻辑回归分析两个队列中基础疾病与结局之间的关联。结果以调整后的比值比（OR）和95%置信区间（CI）表示。
研究结果
共纳入19789例分析病例，其中1476例（7.5%）死亡，2811例（14.2%）住院，438例（2.2%）入住ICU，其中90例（20.5%）死亡。患有慢性心脏病、体重指数（BMI）≥40kg/m²以及男性与死亡率、住院率和ICU收治率显著较高相关。此外，诊断为慢性神经系统疾病（OR 1.41；95%CI：1.17，1.69）、慢性肾病（OR 1.74；95%CI：1.35，2.24）和癌症（OR 2.77；95%CI：2.21，3.47）与所有病例中较高的死亡风险显著相关，住院病例的死亡情况也观察到类似的关联模式。
解读
识别COVID-19病例中的基础疾病可能有助于确定那些健康结局最差风险最高的人群，并为改善结局的预防策略提供依据。
资金来源
本研究由卫生服务执行局卫生保护监测中心资助。KEB和MM分别由卫生研究委员会资助（RL-15-1579和EIA-2019-012）。
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