Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan; Department of Infectious Diseases, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
Respir Investig. 2021 Nov;59(6):810-818. doi: 10.1016/j.resinv.2021.08.005. Epub 2021 Sep 10.
The fourth wave of COVID-19 in Osaka Prefecture, Japan, caused a medical crisis. Here, we aim to identify the risk factors for COVID-19 severity and compare patients between the first-third waves and the fourth wave.
We performed an observational retrospective study of COVID-19 cases at the National Hospital Organization Kinki-Chuo Chest Medical Center.
We identified 404 patients (median age: 71.0 years [interquartile range: 56.0-80.0]), of whom 199 (49.1%) had mild disease, 142 (35.2%) had moderate disease, and 63 (15.6%) had severe disease. The overall mortality rate was 5.4% (22/404). Based on multivariate logistic regression analysis, cardiovascular disease, fever, dyspnea, and several inflammatory biomarkers were independent risk factors for moderate to severe disease. For every 1 mg/dL increase in C-reactive protein, 10 IU/L increase in lactate dehydrogenase, and 100 ng/mL increase in ferritin, the risk for moderate to severe disease increased by 18.3%, 12.9%, and 8.9%, respectively. Overall disease severity in the fourth wave was higher than in the first-third waves. However, there was no significant difference in mortality. Because of a shortage of beds, four of the 28 severe patients (14.3%) in the fourth wave could not be transferred to the advanced hospital.
Cardiovascular disease, fever, dyspnea, and several inflammatory biomarkers were risk factors for moderate to severe COVID-19 in our cohort. During the fourth wave, COVID-19 severity worsened, increasing the number of patients who could not be transferred to beds for severe cases, resulting in a medical crisis in Osaka.
日本大阪府的第四波 COVID-19 疫情导致了医疗危机。在这里，我们旨在确定 COVID-19 严重程度的危险因素，并将前三个波次和第四波次的患者进行比较。
我们对日本国立医院组织近畿中部胸科医疗中心的 COVID-19 病例进行了一项观察性回顾性研究。
我们共确定了 404 名患者（中位年龄：71.0 岁[四分位间距：56.0-80.0]），其中 199 名（49.1%）为轻症，142 名（35.2%）为中度，63 名（15.6%）为重症。总死亡率为 5.4%（22/404）。基于多变量逻辑回归分析，心血管疾病、发热、呼吸困难和几种炎症生物标志物是中重度疾病的独立危险因素。C 反应蛋白每增加 1mg/dL、乳酸脱氢酶增加 10IU/L、铁蛋白增加 100ng/mL，中重度疾病的风险分别增加 18.3%、12.9%和 8.9%。第四波次的整体疾病严重程度高于前三个波次，但死亡率没有显著差异。由于床位短缺，第四波次的 28 名重症患者中有 4 名（14.3%）无法转至高级医院。
心血管疾病、发热、呼吸困难和几种炎症生物标志物是我们队列中中重度 COVID-19 的危险因素。在第四波次期间，COVID-19 的严重程度恶化，导致无法转至重症病床的患者数量增加，从而导致大阪出现医疗危机。
