Signes-Costa Jaime, Núñez-Gil Iván J, Soriano Joan B, Arroyo-Espliguero Ramón, Eid Charbel Maroun, Romero Rodolfo, Uribarri Aitor, Fernández-Rozas Inmaculada, Aguado Marcos García, Becerra-Muñoz Víctor Manuel, Huang Jia, Pepe Martino, Cerrato Enrico, Raposeiras Sergio, Gonzalez Adelina, Franco-Leon Francisco, Wang Lin, Alfonso Emilio, Ugo Fabrizio, García-Prieto Juan Fortunato, Feltes Gisela, Abumayyaleh Mohammad, Espejo-Paeres Carolina, Jativa Jorge, Masjuan Alvaro López, Macaya Carlos, Carbonell Asíns Juan A, Estrada Vicente
Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain.
Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Arch Bronconeumol. 2021 Apr;57:13-20. doi: 10.1016/j.arbres.2020.11.012. Epub 2020 Dec 16.
Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death.
A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored.
1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) ( < 0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR = 1.78; 95%C.I. 1.58-2.01; < 0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44; = 0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death.
Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.
患有基础呼吸系统疾病的COVID-19患者可能有更高的严重并发症甚至死亡风险。
一项对5847例住院COVID-19患者的回顾性、多中心队列研究。患者被分为两组，有/无既往肺部疾病。探讨与生存及次要复合终点（如入住重症监护病房和呼吸支持）相关的因素。
1271例患者（22%）有既往肺部疾病，主要为慢性阻塞性肺疾病（COPD）。376例肺部疾病患者（29.5%）和819例无肺部疾病患者（17.9%）发生全因死亡（P<0.001）。Kaplan-Meier曲线显示，肺部疾病患者30天生存率较差（风险比[HR]=1.78；95%置信区间[C.I.]1.58 - 2.01；P<0.001），COPD患者死亡率近40%。多变量Cox回归显示，既往肺部疾病仍是死亡的危险因素（HR，1.21；95% C.I. 1.02 - 1.44；P = 0.02）。与肺部疾病患者全因死亡风险独立相关的变量为入院时氧饱和度低于92%（HR，4.35；95%置信区间3.08 - 6.15）和D-二聚体升高（HR，1.84；95%置信区间1.27 - 2.67）。年龄小于60岁（HR 0.37；95%置信区间0.21 - 0.65）与死亡风险降低相关。
既往肺部疾病是COVID-19患者死亡的危险因素。年龄较大、男性、家庭氧疗和入院时呼吸衰竭与死亡率增加相关。必须努力识别呼吸系统疾病患者，制定措施以改善其临床结局。
