[2020年3月至6月西班牙塔拉戈纳536名50岁以上实验室确诊的成人新冠肺炎患者的治疗环境、症状、临床病程、严重程度和病死率。]

[Treatment setting, symptomatology, clinical course, severity degree and case-fatality rate in 536 adults over 50 years with laboratory-confirmed COVID-19 in Tarragona, Spain, March-June 2020.].

作者信息

Vila-Córcoles Ángel, Vila-Rovira Ángel, Satué-Gracia Eva María, Ochoa-Gondar Olga, de Diego-Cabanes Cinta, Hospital-Guardiola Immaculada, Forcadell-Peris María José, Martín-Luján Francisco, Basora-Gallisà Josep

机构信息

Servicio de Atención Primaria Camp de Tarragona. Institut Català de la Salut. Tarragona. España.

Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol. Barcelona. España.

出版信息

Rev Esp Salud Publica. 2021 Sep 8;95:e202109115.

PMID:34493700

Abstract

OBJECTIVE

Population-based clinical data on COVID-19 is scarce. This study analyzed distinct clinical characteristics of COVID-19 and relationships with lethality among adults.

METHODS

Retrospective cohort that included all population ≥50 years with a laboratory-confirmed COVID-19 in Tarragona, Spain, during 01/03/2020-30/06/2020. Treatment setting (outpatient/hospital/nursing-home), pre-existing comorbidities, signs/symptoms, clinical course, severity and lethality (death from any cause in-hospital or within the first 30-day after the diagnosis) were determined. Chi squared and Fisher's test were used to compare percentages.

RESULTS

Of the 536 overall cases (mean age: 74 years; 43.8% male), 150 (28%) were outpatient, 179 (33.4%) were hospitalised and 207 (38.6%) happened in nursing-home/social-health centres. The most prevalent symptoms were fever (57.9%), cough (49.8%), dyspnea (41.5%), general discomfort (36.2%), fatigue (24.4%), diarrhea (19.6%), myalgias (17.3%), headache (14.6%), confusion/lethargy (14.6%), thoracic pain (10%), anosmia (9.8%), disgeusia/ageusia (8.1%) and sore throat (7.7%). Global lethality was 23.1% (1.7% in 50-64 years vs 25.5% in 65-79 years vs 38.7% in ≥80 years, p<0.001; 26.8% in men vs 20.3% in women, p=0.075; 3.3% in outpatient vs 29.6% in hospitalised vs 31.9% in nursing-home/social-health centres, p<0.001). By symptomatology, maximum lethality was observed among patients with confusion/lethargy (77.6%) and minimum among those with ageusia/disgeusia (4.8%), anosmia (3.9%) or myalgias (1.1%). By pre-existing comorbidities, greater lethality happened among patients with neurologic (36.7%), renal (35.4%) and cardiac disease (35.3%).

CONCLUSIONS

There was a relatively great lethality of COVID-19 among the general population ≥50 years across the first epidemic wave in the study setting. Increasing age, male sex, nursing-home residence and several signs/symptoms and comorbidities were associated with higher mortality.

摘要

目的

基于人群的新冠病毒病（COVID-19）临床数据稀缺。本研究分析了COVID-19在成年人中的不同临床特征及其与致死率的关系。

方法

回顾性队列研究纳入了2020年3月1日至2020年6月30日期间西班牙塔拉戈纳所有年龄≥50岁且实验室确诊为COVID-19的人群。确定治疗环境（门诊/医院/疗养院）、既往合并症、体征/症状、临床病程、严重程度和致死率（住院期间或诊断后30天内任何原因导致的死亡）。采用卡方检验和费舍尔检验比较百分比。

结果

在536例总体病例中（平均年龄：74岁；男性占43.8%），150例（28%）为门诊患者，179例（33.4%）住院治疗，207例（38.6%）发生在疗养院/社会健康中心。最常见的症状为发热（57.9%）、咳嗽（49.8%）、呼吸困难（41.5%）、全身不适（36.2%）、疲劳（24.4%）、腹泻（19.6%）、肌痛（17.3%）、头痛（14.6%）、意识模糊/嗜睡（14.6%）、胸痛（10%）、嗅觉丧失（9.8%）、味觉减退/味觉丧失（8.1%）和咽痛（7.7%）。总体致死率为23.1%（50 - 64岁为1.7%，65 - 79岁为25.5%，≥80岁为38.7%，p<0.001；男性为26.8%，女性为20.3%，p = 0.075；门诊患者为3.3%，住院患者为29.6%，疗养院/社会健康中心患者为31.9%，p<0.001）。按症状学分类，意识模糊/嗜睡患者的致死率最高（77.6%），味觉减退/味觉丧失、嗅觉丧失或肌痛患者的致死率最低（分别为4.8%、3.9%或1.1%）。按既往合并症分类，神经系统疾病（36.7%）、肾脏疾病（35.4%）和心脏病（35.3%）患者的致死率更高。