慢性心力衰竭与 COVID-19 老年重症监护患者死亡率的关系。
Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19.
机构信息
Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, Salzburg, Austria.
出版信息
ESC Heart Fail. 2022 Jun;9(3):1756-1765. doi: 10.1002/ehf2.13854. Epub 2022 Mar 10.
AIMS
Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19.
METHODS AND RESULTS
Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128).
CONCLUSIONS
In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality.
TRIAL REGISTRATION NUMBER
NCT04321265.
目的
慢性心力衰竭（CHF）是 2019 年冠状病毒病（COVID-19）死亡的主要危险因素。这项前瞻性国际多中心研究调查了在 COVID-19 危重病老年（≥70 岁）重症监护患者中，预先存在的 CHF 对临床结局的影响。
方法和结果
预先存在 CHF 的患者分为缺血性或非缺血性心脏病；有记录射血分数（EF）的患者根据心力衰竭 EF 进一步分类：射血分数降低（HFrEF，n=132）、射血分数轻度降低（HFmrEF，n=91）或射血分数保留（HFpEF，n=103）。在单变量和多变量逻辑回归分析中分析心力衰竭特征与 30 天死亡率的关系。在 3917 名患者中，有 566 名（14%）报告有预先存在的 CHF。CHF 患者年龄更大，身体更虚弱，入院时 SOFA 评分明显更高。CHF 患者的 30 天死亡率[60%比 48%，P<0.001；优势比 1.87，95%置信区间（CI）1.5-2.3]和 3 个月死亡率[69%比 56%，P<0.001]均显著升高。在多变量调整混杂因素（SOFA、年龄、性别和虚弱）后，CHF 与死亡率之间无独立相关性[调整后的优势比（aOR）1.2，95%CI 0.5-1.5；P=0.137]。预先存在的缺血性疾病比非缺血性疾病患者更多[233 例比 328 例（n=5 例病因不明）]。缺血性和非缺血性疾病之间或 HFrEF、HFmrEF 和 HFpEF 之间的基线特征无差异。与 HFpEF 相比，HFrEF 的 30 天死亡率明显更高（64%比 48%，P=0.042）。EF 作为连续变量与 30 天死亡率无独立相关性（aOR 0.98，95%CI 0.9-1.0；P=0.128）。
结论
在危重病老年 COVID-19 患者中，预先存在的 CHF 与 30 天死亡率无独立相关性。
试验注册号
NCT04321265。
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