Ecarnot Fiona, Rebora Paola, Focà Emanuele, Zucchelli Alberto, Citerio Giuseppe, Valsecchi Maria Grazia, Marengoni Alessandra, Bellelli Giuseppe
1EA3920, University of Franche-Comté and Department of Cardiology, University Hospital Besançon, Besançon, France.
2Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Aging Dis. 2022 Apr 1;13(2):340-343. doi: 10.14336/AD.2022.0127. eCollection 2022 Apr.
In patients with COVID-19, frailty has been shown to better predict outcomes than age alone. We investigated factors associated with mechanical ventilation (MV) during hospitalization for COVID-19 among older adults in a multicentre study during the first two waves in Italy. Using data from the FRACOVID project, we included consecutive patients admitted to the participating centres during the first and second waves. We recorded sociodemographics, comorbidities, time since symptom onset, ventilatory support at admission, and chest X-ray findings. Frailty was assessed using a frailty index (FI). Results are reported as hazard ratios (HR) with 95%CI. 1,344 patients were included; 487 females (36.2%), median age 68 (56; 79) years; 52.4% had hypertension, 10.6% had chronic obstructive pulmonary disease, 15.2% were obese. Median FI was 0.088 (0.03, 0.20), and 67% had bilateral consolidations at admission. Median time since symptom onset was 7 days (4, 10). During hospitalization, 47 patients (3.6%, 95%CI 0.33-13.6%) received MV. Multivariable Cox regression analysis found that the likelihood of intubation decreased with increasing age (HR 0.945 (95%CI 0.921-0.969), p<0.0001), while heart rate >110bpm (HR 3.429 (95%CI 1.583-7.429), p=0.0018), and need for continuous positive airway pressure (CPAP) at admission (HR 2.626 (95%CI 1.330-5.186), p=0.0054) were significantly associated with a greater likelihood of intubation. Older patients are less likely to receive intubation, while those with heart rate >110 bpm and need for CPAP at admission are more likely to receive MV during hospitalization for COVID-19.
在新冠肺炎患者中，虚弱已被证明比单纯年龄更能预测预后。我们在意大利前两波疫情期间的一项多中心研究中，调查了老年新冠肺炎患者住院期间与机械通气（MV）相关的因素。利用FRACOVID项目的数据，我们纳入了在第一波和第二波疫情期间入住参与中心的连续患者。我们记录了社会人口统计学、合并症、症状出现后的时间、入院时的通气支持以及胸部X光检查结果。使用虚弱指数（FI）评估虚弱情况。结果以风险比（HR）及95%置信区间（CI）报告。共纳入1344例患者；487例女性（36.2%），中位年龄68（56；79）岁；52.4%患有高血压，10.6%患有慢性阻塞性肺疾病，15.2%为肥胖患者。中位FI为0.088（0.03，0.20），67%的患者入院时双侧有实变。症状出现后的中位时间为7天（4，10）。住院期间，47例患者（3.6%，95%CI 0.33 - 13.6%）接受了MV。多变量Cox回归分析发现，插管的可能性随年龄增加而降低（HR 0.945（95%CI 0.921 - 0.969），p<0.0001），而心率>110次/分（HR 3.429（95%CI 1.583 - 7.429），p = 0.0018）以及入院时需要持续气道正压通气（CPAP）（HR 2.626（95%CI 1.330 - 5.186），p = 0.0054）与插管可能性显著增加相关。老年患者接受插管的可能性较小，而心率>110次/分且入院时需要CPAP的患者在新冠肺炎住院期间接受MV的可能性更大。
