年龄是 COVID-19 相关住院死亡率的主要决定因素，而既往合并症的影响最小，这是一项回顾性队列研究。

Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study.

机构信息

Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.

Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.

出版信息

BMC Geriatr. 2022 Mar 5;22(1):184. doi: 10.1186/s12877-021-02673-1.

DOI:10.1186/s12877-021-02673-1

PMID:35247983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8897728/

Abstract

BACKGROUND

Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown.

METHODS

In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis.

RESULTS

In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p< 0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome.

CONCLUSIONS

Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities.

TRIAL REGISTRATION

CAPACITY-COVID ( NCT04325412 ).

摘要

背景

年龄和合并症会增加 COVID-19 相关的住院死亡率风险，但合并症在多大程度上影响年龄的影响尚不清楚。

方法

本研究为多中心回顾性队列研究，数据来自 45 家荷兰医院，纳入了 45 家荷兰医院（2020 年 2 月至 7 月） CAPACITY-COVID 登记处的 4806 例确诊 COVID-19 住院患者（年龄 69[58-77]岁，64%为男性）。主要结局定义为住院相关死亡率或带姑息治疗的出院的组合。使用 logistic 回归分析来分析性别、年龄和合并症与主要结局之间的关系。使用中介分析评估合并症对年龄与主要结局之间关系的影响。

结果

1108（23%）例患者发生院内 COVID-19 相关死亡，836（76%）例患者年龄≥70 岁（70+）。年龄 70+和女性在单变量分析中与结局相关（比值比[OR]4.68，95%置信区间[4.02-5.45]；OR0.68[0.59-0.79]；均 p<0.001）。所有合并症在单变量分析中与结局相关（p<0.001），但调整年龄 70+和性别后，只有血脂异常无显著相关性。在年龄样条调整后，合并症的影响减弱，仅女性、糖尿病（DM）、慢性肾脏病（CKD）和慢性阻塞性肺疾病（COPD）与结局显著相关（女性 OR0.65[0.55-0.75]；DM OR1.47[1.26-1.72]；CKD OR1.61[1.32-1.97]；COPD OR1.30[1.07-1.59]）。老年患者的预先存在的合并症（所有合并症中<6%）对较高年龄与结局之间的关联影响较小。