意大利米兰疫情前 3 波期间住院 COVID-19 患者的死亡率：一项前瞻性观察研究。
Mortality rates among COVID-19 patients hospitalised during the first three waves of the epidemic in Milan, Italy: A prospective observational study.
机构信息
Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy.
Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
出版信息
PLoS One. 2022 Apr 11;17(4):e0263548. doi: 10.1371/journal.pone.0263548. eCollection 2022.
INTRODUCTION
This paper describes how mortality among hospitalised COVID-19 patients changed during the first three waves of the epidemic in Italy.
METHODS
This prospective cohort study used the Kaplan-Meier method to analyse the time-dependent probability of death of all of the patients admitted to a COVID-19 referral centre in Milan, Italy, during the three consecutive periods of: 21 February-31 July 2020 (first wave, W1), 1 August 2020-31 January 2021 (second wave, W2), and 1 February-30 April 2021 (third wave, W3). Cox models were used to examine the association between death and the period of admission after adjusting for age, biological sex, the time from symptom onset to admission, disease severity upon admission, obesity, and the comorbidity burden.
RESULTS
Of the 2,023 COVID-19 patients admitted to our hospital during the study period, 553 (27.3%) were admitted during W1, 838 (41.5%) during W2, and 632 (31.2%) during W3. The crude mortality rate during W1, W2 and W3 was respectively 21.3%, 23.7% and 15.8%. After adjusting for potential confounders, hospitalisation during W2 or W3 was independently associated with a significantly lower risk of death than hospitalisation during W1 (adjusted hazard ratios [AHRs]: 0.75, 95% confidence interval [CI] 0.59-0.95, and 0.58, 95% CI 0.44-0.77). Among the patients aged >75 years, there was no significant difference in the probability of death during the three waves (AHRs during W2 and W3 vs W1: 0.93, 95% CI 0.65-1.33, and 0.88, 95% CI 0.59-1.32), whereas those presenting with critical disease during W2 and W3 were at significantly lower risk of dying than those admitted during W1 (AHRs 0.61, 95% CI 0.43-0.88, and 0.44, 95% CI 0.28-0.70).
CONCLUSIONS
Hospitalisation during W2 and W3 was associated with a reduced risk of COVID-19 death in comparison with W1, but there was no difference in survival probability in patients aged >75 years.
引言
本文描述了意大利 COVID-19 住院患者死亡率在疫情的前三个波次期间的变化情况。
方法
本前瞻性队列研究采用 Kaplan-Meier 方法分析了意大利米兰一家 COVID-19 转诊中心连续三个时期所有住院患者的死亡时间依赖性概率：2020 年 2 月 21 日至 7 月 31 日（第一波，W1）、2020 年 8 月 1 日至 2021 年 1 月 31 日（第二波，W2）和 2021 年 2 月 1 日至 4 月 30 日（第三波，W3）。采用 Cox 模型，在调整年龄、生物学性别、症状出现到入院时间、入院时疾病严重程度、肥胖和合并症负担后，分析死亡与入院期间的相关性。
结果
在研究期间，共有 2023 例 COVID-19 患者入住我院，其中 553 例（27.3%）入住 W1，838 例（41.5%）入住 W2，632 例（31.2%）入住 W3。W1、W2 和 W3 的粗死亡率分别为 21.3%、23.7%和 15.8%。在调整潜在混杂因素后，与 W1 相比，W2 或 W3 住院与死亡风险显著降低相关（调整后的危害比 [AHR]：0.75，95%置信区间 [CI]：0.59-0.95 和 0.58，95%CI：0.44-0.77）。对于年龄>75 岁的患者，在三个波次期间死亡的概率没有显著差异（W2 和 W3 与 W1 的 AHR：0.93，95%CI：0.65-1.33 和 0.88，95%CI：0.59-1.32），而 W2 和 W3 期间危重症患者的死亡风险显著低于 W1 （AHRs：0.61，95%CI：0.43-0.88 和 0.44，95%CI：0.28-0.70）。
结论
与 W1 相比，W2 和 W3 住院与 COVID-19 死亡风险降低相关，但>75 岁患者的生存概率无差异。
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