血管合并症使因 COVID-19 住院的心衰患者预后恶化。
Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19.
机构信息
Internal Medicine, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA
Internal Medicine, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA.
出版信息
Open Heart. 2021 Jun;8(1). doi: 10.1136/openhrt-2021-001668.
BACKGROUND
Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown.
OBJECTIVE
This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19.
METHODS
Case-control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19.
RESULTS
Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011).
CONCLUSION
Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.
背景
先前诊断为心力衰竭（HF）与 COVID-19 导致的住院时间（LOS）延长和死亡率增加有关。在因 COVID-19 住院的 HF 患者中，物质使用、静脉血栓栓塞（VTE）或外周动脉疾病（PAD）及其对 LOS 或死亡率的影响之间的关联尚不清楚。
目的
本研究确定了与因 COVID-19 住院的 HF 患者不良住院结局相关的危险因素。
方法
对 2020 年 1 月 1 日至 2021 年 2 月 28 日在学术三级护理中心因 COVID-19 住院的 HF 患者进行病例对照研究。将 HF 患者与 COVID-19 住院患者的危险因素进行比较，比较有无危险因素的患者的临床特征、 LOS 和死亡率。进行多变量回归分析，以确定因 COVID-19 住院的 HF 患者 LOS 和住院内死亡率增加的多个预测因素。
结果
共有 211 例 HF 患者因 COVID-19 住院。女性的 LOS 长于男性（9 天 vs 7 天；p<0.001）。与无 PAD 或缺血性脑卒中的患者相比，有 PAD 或缺血性脑卒中的患者的 LOS 更长（7 天 vs 9 天；p=0.012 和 7 天 vs 11 天，p<0.001）。与年轻患者相比，年龄在 65 岁及以上的患者住院内死亡率更高（调整后的 OR：1.04；95%CI 1.00 至 1.07；p=0.036）。因 COVID-19 住院的 HF 患者中，先前诊断为 VTE 使死亡率增加了两倍多（调整后的 OR：3.33；95%CI 1.29 至 8.43；p=0.011）。
结论
血管疾病增加了因 COVID-19 住院的 HF 患者的 LOS 和死亡率。
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