Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine.
Hallym University Kidney Research Institute, Seoul.
Medicine (Baltimore). 2021 May 7;100(18):e25900. doi: 10.1097/MD.0000000000025900.
Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16-3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49-3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59-2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94-1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33-2.43), and male sex (HR 1.76, CI 1.32-2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
患有合并症的老年患者在感染 2019 年冠状病毒病（COVID-19）的患者中死亡率和严重临床结局较高。然而，年龄调整后的 Charlson 合并症指数评分（CCIS）是否可预测死亡结局尚不确定。这项回顾性的全国性队列研究评估了 COVID-19 感染住院患者的 CCIS 与死亡率和临床结局的关系。我们纳入了 5621 名于 2020 年 4 月 30 日前从隔离中出院或因 COVID-19 死亡的患者。主要结局是死亡、入住重症监护病房、使用机械通气或体外膜氧合的综合结局。次要结局是死亡率。多变量 Cox 比例风险模型用于评估 CCIS 作为死亡的独立危险因素。在 5621 名患者中，高 CCIS（≥3）组的老年人口比例较高，血浆血红蛋白和淋巴细胞及血小板计数较低。高 CCIS 组是复合结局（HR3.63，95%CI2.45-5.37，P<0.001）和患者死亡（HR22.96，95%CI7.20-73.24，P<0.001）的独立危险因素。列线图显示，CCIS 是影响预后的最重要因素，其次是呼吸困难（危险比[HR]2.88，95%置信区间[CI]2.16-3.83）、低体重指数（<18.5kg/m2）（HR2.36，CI1.49-3.75）、淋巴细胞减少症（<0.8×109/L）（HR2.15，CI1.59-2.91）、血小板减少症（<150.0×109/L）（HR1.29，CI0.94-1.78）、贫血（<12.0g/dL）（HR1.80，CI1.33-2.43）和男性（HR1.76，CI1.32-2.34）。该列线图表明，CCIS 是预测患者死亡的最有力的预测因素。用于 COVID-19 住院患者的 CCIS 预测列线图可帮助临床医生对高危人群进行分诊，并集中有限的资源对其进行管理。
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