美国中西部一大群在疫苗可用之前因新冠肺炎住院的患者的临床特征、风险因素及预后
Clinical Characteristics, Risk Factors, and Outcomes Among a Large Midwestern U.S. Cohort of Patients Hospitalized With COVID-19 Prior to Vaccine Availability.
作者信息
Zlochiver Viviana, Perez Moreno Ana Cristina, Peterson Michael, Odeh Khalil, Mainville Ashley, Busniewski Katherine, Wrobel Jon, Hommeida Mohamed, Tilkens Blair, Sharma Payal, Vang Hlu, Walczak Sara, Moges Fekadesilassie, Garg Kritika, Jamil Tajik A, Allaqaband Suhail Q, Bajwa Tanvir, Jan M Fuad
机构信息
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI.
Department of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
出版信息
J Patient Cent Res Rev. 2022 Apr 18;9(2):132-141. doi: 10.17294/2330-0698.1889. eCollection 2022 Spring.
PURPOSE
The COVID-19 pandemic posed unprecedented demands on health care. This study aimed to characterize COVID-19 inpatients and examine trends and risk factors associated with hospitalization duration, intensive care unit (ICU) admission, and in-hospital mortality.
METHODS
This retrospective study analyzed patients with SARS-CoV-2 infection hospitalized at an integrated health system between February 2, 2020, and December 12, 2020. Patient characteristics and clinical outcomes were obtained from medical records. Backward stepwise logistic regression analyses were used to identify independent risk factors of ICU admission and in-hospital mortality. Cox proportional hazards models were used to evaluate relationships between ICU admission and in-hospital mortality.
RESULTS
Overall, 9647 patients were analyzed. Mean age was 64.6 ± 18 years. A linear decrease was observed for hospitalization duration (0.13 days/week, R=0.71; P<0.0001), ICU admissions (0.35%/week, R=0.44; P<0.001), and hospital mortality (0.16%/week, R=0.31; P<0.01). Bacterial co-infections, male sex, history of chronic lung and heart disease, diabetes, and Hispanic ethnicity were identified as independent predictors of ICU admission (P<0.001). ICU admission and age of ≥65 years were the strongest independent risk factors associated with in-hospital mortality (P<0.001). The in-hospital mortality rate was 8.3% (27.4% in ICU patients, 2.6% in non-ICU patients; P<0.001).
CONCLUSIONS
Results indicate that, over the pandemic's first 10 months, COVID-19 carried a heavy burden of morbidity and mortality in older patients (>65 years), males, Hispanics, and those with bacterial co-infections and chronic comorbidities. Although disease severity has steadily declined following administration of COVID-19 vaccines along with improved understanding of effective COVID-19 interventions, these study findings reflect a "natural history" for this novel infectious disease in the U.S. Midwest.
目的
新型冠状病毒肺炎（COVID-19）大流行对医疗保健提出了前所未有的要求。本研究旨在描述COVID-19住院患者的特征，并研究与住院时间、重症监护病房（ICU）收治情况及院内死亡率相关的趋势和风险因素。
方法
这项回顾性研究分析了2020年2月2日至2020年12月12日期间在一个综合医疗系统住院的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者。从病历中获取患者特征和临床结局。采用向后逐步逻辑回归分析来确定ICU收治和院内死亡的独立危险因素。使用Cox比例风险模型来评估ICU收治与院内死亡之间的关系。
结果
总体而言，共分析了9647例患者。平均年龄为64.6±18岁。观察到住院时间呈线性下降（0.13天/周，R=0.71；P<0.0001）、ICU收治情况呈线性下降（0.35%/周），R=0.44；P<0.001）以及院内死亡率呈线性下降（0.16%/周，R=0.31；P<0.01）。细菌合并感染、男性、慢性肺病和心脏病史、糖尿病以及西班牙裔被确定为ICU收治的独立预测因素（P<0.001）。ICU收治和年龄≥65岁是与院内死亡相关的最强独立危险因素（P<0.001）。院内死亡率为8.3%（ICU患者为27.4%，非ICU患者为2.6%；P<0.001）。
结论
结果表明，在大流行的前10个月里，COVID-19给老年患者（>65岁）、男性、西班牙裔以及合并细菌感染和慢性合并症的患者带来了沉重的发病和死亡负担。尽管在接种COVID-19疫苗以及对有效的COVID-19干预措施的认识提高之后，疾病严重程度稳步下降，但这些研究结果反映了这种新型传染病在美国中西部的“自然病程”。
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