美国军事卫生系统受益人群中的新冠病毒病结局包括多器官系统并发症和严重功能损害。
COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment.
作者信息
Richard Stephanie A, Pollett Simon D, Lanteri Charlotte A, Millar Eugene V, Fries Anthony C, Maves Ryan C, Utz Gregory C, Lalani Tahaniyat, Smith Alfred, Mody Rupal M, Ganesan Anuradha, Colombo Rhonda E, Colombo Christopher J, Lindholm David A, Madar Cristian, Chi Sharon, Huprikar Nikhil, Larson Derek T, Bazan Samantha E, English Caroline, Parmelee Edward, Mende Katrin, Laing Eric D, Broder Christopher C, Blair Paul W, Chenoweth Josh G, Simons Mark P, Tribble David R, Agan Brian K, Burgess Timothy H
机构信息
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
出版信息
Open Forum Infect Dis. 2021 Nov 10;8(12):ofab556. doi: 10.1093/ofid/ofab556. eCollection 2021 Dec.
BACKGROUND
We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review.
METHODS
MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression.
RESULTS
A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post-symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45-64 and 65+ compared with <45), and obesity (BMI≥30 compared with BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post-symptom onset.
CONCLUSIONS
Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.
背景
我们在美国军事卫生系统（MHS）的一个前瞻性队列中，对现役军人、退休人员及其家属群体进行了2019冠状病毒病（COVID-19）感染1个月后的临床结局、功能负担和并发症评估，采用了系列患者报告结局调查和电子病历（EMR）回顾。
方法
在美国9个地点就诊的MHS受益人，若严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性、患有类似COVID-19的疾病或有高风险的SARS-CoV-2暴露，则符合入组条件。通过结构化访谈和基于国际疾病分类的EMR回顾收集病史和临床结局。通过多因素逻辑回归确定与住院相关的危险因素。
结果
共纳入1202名参与者。其中有1070例实验室确诊的SARS-CoV-2病例和132例SARS-CoV-2检测阴性的参与者。在SARS-CoV-2阳性病例症状出现后的第一个月，有212人住院，80%需要吸氧，20人入住重症监护病房，10人死亡。与COVID-19相关住院的危险因素包括种族（与非西班牙裔白人相比，亚洲人、黑人和西班牙裔的住院风险增加）、年龄（45 - 64岁和65岁以上与45岁以下相比）以及肥胖（体重指数≥30与体重指数<30相比）。超过2%的调查受访者表示需要补充氧气，31%的人在症状出现后1个月尚未恢复正常日常活动。
结论
年龄较大、报告为亚洲人、黑人或西班牙裔种族以及肥胖与SARS-CoV-2住院相关。一部分急性SARS-CoV-2感染需要长期氧疗；SARS-CoV-2感染对短期功能状态的影响很大。相当数量的MHS受益人在1个月时仍未恢复正常活动。
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