Radiology Department, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.
Radiology Unit, Scientific Institute of Romagna for the Study and Treatment of Tumors (IRST) IRCCS, Meldola, Italy.
Endocrine. 2021 Dec;74(3):461-469. doi: 10.1007/s12020-021-02872-1. Epub 2021 Sep 16.
Bone fragility has been linked to COVID-19 severity. The objective of this study was to evaluate whether a diagnosis of vertebral fracture (VF) increased mortality risk in COVID-19 patients and whether this effect was greater than in those without COVID-19.
We assessed VFs by computed tomography (CT) in a cohort of 501 patients consecutively admitted to the emergency department (ED) for clinical suspicion of SARS-CoV-2 infection during the first wave of pandemic emergency. Of those, 239 had a confirmed diagnosis of COVID-19.
VF prevalence was similar between COVID-19 and non-COVID-19 groups (22.2 vs. 19%; p = 0.458). Death rates were similar between COVID-19 and non-COVID-19 groups at both 30 (15.8 vs. 12.2%; p = 0.234) and 120 days (21.8 vs. 17.6%; p = 0.236). The mortality risk was higher in COVID-19 patients either with one or multiple fractures compared to those without VFs, at 30 and 120 days, but statistical significance was reached only in those with multiple VFs (30-day HR 3.03, 95% CI 1.36-6.75; 120-day HR 2.91, 95% CI 1.43-5.91). In the non-COVID-19 group, the 30-day mortality risk was significantly higher in patients either with one (HR 7.46, 95% CI 3.12-17.8) or multiple fractures (HR 6.2, 95% CI 2.75-13.98) compared to those without VFs. A similar effect was observed at 120 days. After adjustment for age, sex and bone density, mortality risk remained associated with VFs in the non-COVID-19 group only.
VFs were not independently associated with short-term mortality in patients with COVID-19, but they strongly increased mortality risk in those without COVID-19.
骨脆性与 COVID-19 的严重程度有关。本研究旨在评估诊断为椎体骨折 (VF) 是否会增加 COVID-19 患者的死亡率，以及这种影响是否大于非 COVID-19 患者。
我们通过计算机断层扫描 (CT) 评估了 501 名连续入住急诊科的患者的 VF，这些患者因临床怀疑 SARS-CoV-2 感染而入院。其中 239 例确诊为 COVID-19。
VF 在 COVID-19 和非 COVID-19 组之间的发生率相似（22.2% vs. 19%；p=0.458）。COVID-19 和非 COVID-19 组在 30 天（15.8% vs. 12.2%；p=0.234）和 120 天（21.8% vs. 17.6%；p=0.236）的死亡率相似。与无 VF 的患者相比，无论 COVID-19 患者有一处或多处骨折，其死亡风险均更高，但仅在多处 VF 患者中具有统计学意义（30 天 HR 3.03，95%CI 1.36-6.75；120 天 HR 2.91，95%CI 1.43-5.91）。在非 COVID-19 组中，与无 VF 的患者相比，无论患者有一处（HR 7.46，95%CI 3.12-17.8）还是多处骨折（HR 6.2，95%CI 2.75-13.98），30 天的死亡率均显著更高。在 120 天也观察到了类似的效果。在校正年龄、性别和骨密度后，仅在非 COVID-19 组中，死亡率仍与 VF 相关。
VF 与 COVID-19 患者的短期死亡率无关，但与非 COVID-19 患者的死亡率密切相关。
