美国急诊科患者急性和恢复期 SARS-CoV-2 感染的人口统计学和临床相关性。
Demographic and clinical correlates of acute and convalescent SARS-CoV-2 infection among patients of a U.S. emergency department.
机构信息
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD, United States of America; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
出版信息
Am J Emerg Med. 2021 Oct;48:261-268. doi: 10.1016/j.ajem.2021.04.081. Epub 2021 Apr 30.
BACKGROUND
Emergency Departments (EDs) have served as critical surveillance sites for infectious diseases. We sought to determine the prevalence and temporal trends of acute (by PCR) and convalescent (by antibody [Ab]) SARS-CoV-2 infection during the earliest phase of the pandemic among patients in an urban ED in Baltimore City.
METHODS
We tested remnant blood samples from 3255 unique ED patients, collected between March 16th and May 31st 2020 for SARS-CoV-2 Ab. PCR for acute SARS-CoV-2 infection from nasopharyngeal swabs was obtained on any patients based on clinical suspicion. Hospital records were abstracted and factors associated with SARS-CoV-2 infection were assessed.
RESULTS
Of 3255 ED patients, 8.2% (95%CI: 7.3%, 9.2%) individuals had evidence of SARS-CoV-2 infection; 155 PCR+, 78 Ab+, and 35 who were both PCR+ and Ab+. Prevalence of disease increased throughout the study period, ranging from 3.2% (95%CI: 1.8%, 5.2%) PCR+ and 0.6% (95%CI: 0.1%, 1.8%) Ab+ in March, to 6.2% (95%CI: 5.1%, 7.4%) PCR+ and 4.2% (95%CI: 3.3%, 5.3%) Ab+ in May. The highest SARS-CoV-2 prevalence was found in Hispanic individuals who made up 8.4% (95%CI: 7.4%, 9.4%) of individuals screened, but 35% (95%CI: 29%, 41%) of infections (PCR and/or Ab+). Demographic and clinical factors independently associated with acute infection included Hispanic ethnicity, loss of smell or taste, subjective fever, cough, muscle ache and fever. Factors independently associated with convalescent infection were Hispanic ethnicity and low oxygen saturation.
CONCLUSIONS
The burden of COVID-19 in Baltimore City increased dramatically over the 11-week study period and was disproportionately higher among Hispanic individuals. ED-based surveillance methods are important for identifying both acute and convalescent SARS-CoV-2 infections and provides important information regarding demographic and clinical correlates of disease in the local community.
背景
急诊科（EDs）一直是传染病的重要监测点。我们旨在确定巴尔的摩市城市急诊科最早阶段期间，急性（通过 PCR）和恢复期（通过抗体 [Ab]）SARS-CoV-2 感染的流行率和时间趋势。
方法
我们对 2020 年 3 月 16 日至 5 月 31 日采集的 3255 名独特 ED 患者的剩余血液样本进行 SARS-CoV-2 Ab 检测。对有临床怀疑的任何患者进行鼻咽拭子急性 SARS-CoV-2 感染的 PCR 检测。提取医院记录并评估与 SARS-CoV-2 感染相关的因素。
结果
在 3255 名 ED 患者中，8.2%（95%CI：7.3%，9.2%）的个体有 SARS-CoV-2 感染证据；155 例 PCR+，78 例 Ab+，35 例 PCR+和 Ab+。疾病的患病率在整个研究期间均有所增加，范围从 3 月的 3.2%（95%CI：1.8%，5.2%）PCR+和 0.6%（95%CI：0.1%，1.8%）Ab+，到 5 月的 6.2%（95%CI：5.1%，7.4%）PCR+和 4.2%（95%CI：3.3%，5.3%）Ab+。在接受筛查的人群中，占 8.4%（95%CI：7.4%，9.4%）的西班牙裔个体 SARS-CoV-2 患病率最高，但感染率为 35%（95%CI：29%，41%）（PCR 和/或 Ab+）。与急性感染独立相关的人口统计学和临床因素包括西班牙裔、嗅觉或味觉丧失、主观发热、咳嗽、肌肉疼痛和发热。与恢复期感染独立相关的因素是西班牙裔和低血氧饱和度。
结论
巴尔的摩市 COVID-19 的负担在 11 周的研究期间急剧增加，并且在西班牙裔人群中比例过高。基于急诊科的监测方法对于识别急性和恢复期 SARS-CoV-2 感染非常重要，并提供了有关当地社区疾病的人口统计学和临床相关性的重要信息。
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