Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Italy.
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Eur J Intern Med. 2021 Jul;89:81-86. doi: 10.1016/j.ejim.2021.04.007. Epub 2021 Apr 19.
heart failure (HF) and coronary artery disease (CAD) are independent predictors of death in patients with COVID-19. The adverse prognostic impact of the combination of HF and CAD in these patients is unclear.
we analysed data from 954 consecutive patients hospitalized for SARS-CoV-2 in five Italian Hospitals from February 23 to May 22, 2020. The study was a systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the outcome measure. Mean duration of hospitalization was 33 days. Mortality was 11% in the total population and 7.4% in the group without evidence of HF or CAD (reference group). Mortality was 11.6% in the group with CAD and without HF (odds ratio [OR]: 1.6, p = 0.120), 15.5% in the group with HF and without CAD (OR: 2.3, p = 0.032), and 35.6% in the group with CAD and HF (OR: 6.9, p<0.0001). The risk of mortality in patients with CAD and HF combined was consistently higher than the sum of risks related to either disorder, resulting in a significant synergistic effect (p<0.0001) of the two conditions. Age-adjusted attributable proportion due to interaction was 64%. Adjusting for the simultaneous effects of age, hypotension, and lymphocyte count did not significantly lower attributable proportion which persisted statistically significant (p = 0.0360).
The combination of HF and CAD exerts a marked detrimental impact on the risk of mortality in hospitalized patients with COVID-19, which is independent on other adverse prognostic markers.
心力衰竭（HF）和冠状动脉疾病（CAD）是 COVID-19 患者死亡的独立预测因素。这些患者中 HF 和 CAD 合并的不良预后影响尚不清楚。
我们分析了 2020 年 2 月 23 日至 5 月 22 日，5 家意大利医院因 SARS-CoV-2 住院的 954 例连续患者的数据。该研究是根据预先规定的方案进行的系统前瞻性数据收集。住院期间的全因死亡率是主要结局指标。住院平均时间为 33 天。总人群的死亡率为 11%，无 HF 或 CAD 证据的组（参考组）的死亡率为 7.4%。CAD 而无 HF 的组的死亡率为 11.6%（比值比 [OR]：1.6，p=0.120），HF 而无 CAD 的组的死亡率为 15.5%（OR：2.3，p=0.032），CAD 和 HF 的组的死亡率为 35.6%（OR：6.9，p<0.0001）。CAD 和 HF 合并患者的死亡风险始终高于任何一种疾病相关风险的总和，这导致了两种疾病的协同作用具有统计学意义（p<0.0001）。由于相互作用的年龄调整归因比例为 64%。调整年龄、低血压和淋巴细胞计数的同时影响并没有显著降低归因比例，该比例仍然具有统计学意义（p=0.0360）。
HF 和 CAD 的合并对 COVID-19 住院患者的死亡率风险产生明显的不利影响，这独立于其他不良预后标志物。
