Hoertel Nicolas, Sánchez-Rico Marina, de la Muela Pedro, Abellán Miriam, Blanco Carlos, Leboyer Marion, Cougoule Céline, Gulbins Erich, Kornhuber Johannes, Carpinteiro Alexander, Becker Katrin Anne, Vernet Raphaël, Beeker Nathanaël, Neuraz Antoine, Alvarado Jesús M, Herrera-Morueco Juan José, Airagnes Guillaume, Lemogne Cédric, Limosin Frédéric
Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France.
Institut National de la Santé et de la Recherche Médicale (INSERM) U1266, Paris, France.
Biol Psychiatry Glob Open Sci. 2023 Jan;3(1):56-67. doi: 10.1016/j.bpsgos.2021.12.007. Epub 2022 Jan 4.
Prior research suggests that psychiatric disorders could be linked to increased mortality among patients with COVID-19. However, whether all or specific psychiatric disorders are intrinsic risk factors of death in COVID-19 or whether these associations reflect the greater prevalence of medical risk factors in people with psychiatric disorders has yet to be evaluated.
We performed an observational, multicenter, retrospective cohort study to examine the association between psychiatric disorders and mortality among patients hospitalized for laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals.
Of 15,168 adult patients, 857 (5.7%) had an ICD-10 diagnosis of psychiatric disorder. Over a mean follow-up period of 14.6 days (SD = 17.9), 326 of 857 (38.0%) patients with a diagnosis of psychiatric disorder died compared with 1276 of 14,311 (8.9%) patients without such a diagnosis (odds ratio 6.27, 95% CI 5.40-7.28, < .01). When adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial, this association remained significant (adjusted odds ratio 3.27, 95% CI 2.78-3.85, < .01). However, additional adjustments for obesity and number of medical conditions resulted in a nonsignificant association (adjusted odds ratio 1.02, 95% CI 0.84-1.23, = .86). Exploratory analyses after the same adjustments suggested that a diagnosis of mood disorders was significantly associated with reduced mortality, which might be explained by the use of antidepressants.
These findings suggest that the increased risk of COVID-19-related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population and not by the underlying psychiatric disease.
先前的研究表明，精神疾病可能与新冠病毒病（COVID-19）患者死亡率增加有关。然而，所有精神疾病或特定精神疾病是否为COVID-19死亡的内在危险因素，或者这些关联是否反映了精神疾病患者中存在更多的医学危险因素，仍有待评估。
我们开展了一项观察性、多中心、回顾性队列研究，以探讨在36家大巴黎地区大学医院因实验室确诊的COVID-19住院的患者中，精神疾病与死亡率之间的关联。
在15168例成年患者中，857例（5.7%）有国际疾病分类第十版（ICD-10）诊断的精神疾病。在平均14.6天（标准差=17.9）的随访期内，857例诊断为精神疾病的患者中有326例（38.0%）死亡，而14311例未诊断为精神疾病的患者中有1276例（8.9%）死亡（比值比6.27，95%置信区间5.40-7.28，P<0.01）。在根据同情用药或作为临床试验一部分对年龄、性别、医院、当前吸烟状况和药物进行调整后，这种关联仍然显著（调整后比值比3.27，95%置信区间2.78-3.85，P<0.01）。然而，对肥胖和疾病数量进行额外调整后，关联不再显著（调整后比值比1.02，95%置信区间0.84-1.23，P=0.86）。在相同调整后的探索性分析表明，情绪障碍诊断与死亡率降低显著相关，这可能是由于使用了抗抑郁药。
这些发现表明，因COVID-19住院的精神疾病患者中与COVID-19相关的死亡风险增加，可能是由于该人群中更多的疾病数量和更高的肥胖患病率，而非潜在的精神疾病。
