Shefa Neuroscience Research Center, Khatamol Anbya Hospital, Tehran, Iran.
Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Am J Emerg Med. 2022 Jan;51:144-149. doi: 10.1016/j.ajem.2021.09.053. Epub 2021 Sep 25.
This study aims to assess the prognosis of inpatients with COVID-19 infection who have a history of sulfur mustard exposure.
We started a cohort study in October 2020 and ended in May 2021 on inpatients with COVID-19 infection who had been admitted to university healthcare centers. The analytic sample included 960 inpatients having COVID-19 infection (192 with; and 768 without sulfur mustard exposure). The exposed patients were male war veterans, and the unexposed patients were male individually age-matched people. All patients had a positive RT-PCR test and a positive chest CT for COVID-19. The outcome was death within 28 days of admission, and the predictors were clinical features recorded at patients' bedsides.
There was a significantly higher prevalence for asthma (p = 0.026) and pulmonary disease other than asthma (p < 0.001) in patients with the exposure. Sulfur mustard exposure was associated with increased risk for mortality of COVID-19 [hazard ratio (95% CI) = 1.92 (1.14,3.24), p = 0.013]. Early intubation signified a poor prognosis [hazard = 7.34 (4.65,11.58), p < 0.001]. However, individuals with higher PaO2 [hazard = 0.97 (0.95,0.98), p < 0.001], or people undergoing O2 therapy early upon admission [hazard = 0.58 (0.38,0.89), p = 0.011] showed lower risks for mortality. Individuals with asthma were at higher risk for mortality [hazard = 3.76 (1.69,8.36), p = 0.001].
Individuals with COVID-19 infection and sulfur mustard exposure should be considered high-risk patients and that, healthcare settings should be ready to provide critical care for them, including O therapy. They are more likely to have asthma or other pulmonary diseases.
本研究旨在评估有硫芥暴露史的 COVID-19 感染住院患者的预后。
我们于 2020 年 10 月开始对入住大学保健中心的 COVID-19 感染住院患者进行队列研究，并于 2021 年 5 月结束。分析样本包括 960 例 COVID-19 感染住院患者（192 例有硫芥暴露，768 例无硫芥暴露）。暴露组患者为男性退伍军人，非暴露组患者为男性个体年龄匹配者。所有患者的 RT-PCR 检测和胸部 CT 均为 COVID-19 阳性。结局为入院后 28 天内死亡，预测因子为患者床边记录的临床特征。
暴露组患者中哮喘（p=0.026）和除哮喘以外的肺部疾病的患病率显著更高。硫芥暴露与 COVID-19 死亡率增加相关[风险比（95%CI）=1.92（1.14，3.24），p=0.013]。早期插管表示预后不良[风险比=7.34（4.65，11.58），p<0.001]。然而，PaO2 较高的个体[风险比=0.97（0.95，0.98），p<0.001]或早期接受氧疗的个体[风险比=0.58（0.38，0.89），p=0.011]死亡率较低。有哮喘的个体死亡率较高[风险比=3.76（1.69，8.36），p=0.001]。
COVID-19 感染和硫芥暴露的个体应被视为高危患者，医疗机构应准备为其提供重症监护，包括氧疗。他们更有可能患有哮喘或其他肺部疾病。
