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与 COVID-19 死亡率、住院时间和诊断相关的因素:来自野战医院的数据。

Factors associated with mortality, length of hospital stay and diagnosis of COVID-19: Data from a field hospital.

机构信息

National School of Public Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.

National School of Public Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil; Pharmaceutical Sciences Research Laboratory (LAPESF), State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.

出版信息

J Infect Public Health. 2022 Jul;15(7):800-805. doi: 10.1016/j.jiph.2022.06.010. Epub 2022 Jun 21.

Abstract

BACKGROUND

During the pandemic of COVID-19, phylogenetic changes have been observed in the characteristics of the virus, in the diagnosis and treatment of the disease. The clinical course and the severe form of the disease depends on several factors. This study characterized the beginning setting for patient care of COVID-19 in a referral center in one of the main capital cities of Brazil. In addition, were evaluated the factors associated with mortality, length of stay, and diagnostic outcome.

METHODS

A cross-sectional study was conducted during May 2020 (n = 1100). The association of the variables with outcome was evaluated by a multivariable logistic regression model, using odds ratios (OR) and 95 % confidence intervals (CI).

RESULTS

Overall, 76 % of patients were COVID-19 positive, and 70 % were diagnosed by RT-qPCR. The majority were male (56 %), and over 52 years old (74 %), 68 % had hypertension, 44 % had diabetes mellitus, and 32 % were obese. The mean length of stay was 10 ± 8 days, which was higher in the 34 % who died (≥14; OR=2; 95 %CI=1.4-4) and who had hypertension (OR=2; 95 %CI=1.3-3) (P < 0.001). The mean length of stay was also higher (P = 0.008) for those patients with pulmonary impairment ≥ 50 % (10.72 ± 8.24), than those with< 50 % (8.98 ± 6.81). Age (>62 and 65 years) was associated with longer hospitalization (OR=2; 95 %CI=1.4-3) and death (OR=6; 95 %CI=3-11). The time of sample collection for RT-qPCR was different between positive and negative tests (P = 0.001), with the time of 4-10 days showing a greater chance for virus detection (OR=2.9; 95 %CI=1.6-5).

CONCLUSION

Death was associated with age and pulmonary impairment. The length of hospitalization was associated with age, hypertension, pulmonary impairment and death. The time of sample collection to perform RT-qPCR and the rapid test was associated with a positive result for COVID-19. These results highlight the ongoing challenge of diagnosing, treating, and mitigating the effects caused by the COVID-19 pandemic.

摘要

背景

在 COVID-19 大流行期间,病毒特征在诊断和治疗疾病方面发生了系统发育变化。疾病的临床过程和严重程度取决于多种因素。本研究在巴西主要首都之一的转诊中心描述了 COVID-19 患者护理的开始情况。此外,还评估了与死亡率、住院时间和诊断结果相关的因素。

方法

2020 年 5 月进行了一项横断面研究(n=1100)。使用比值比(OR)和 95%置信区间(CI)通过多变量逻辑回归模型评估变量与结局的相关性。

结果

总体而言,76%的患者 COVID-19 检测呈阳性,70%通过 RT-qPCR 确诊。大多数患者为男性(56%),年龄超过 52 岁(74%),68%患有高血压,44%患有糖尿病,32%肥胖。平均住院时间为 10±8 天,在 34%死亡(≥14;OR=2;95%CI=1.4-4)和患有高血压(OR=2;95%CI=1.3-3)的患者中更高(P<0.001)。肺部损伤≥50%(10.72±8.24)的患者的平均住院时间也高于肺部损伤<50%(8.98±6.81)的患者(P=0.008)。年龄(>62 和 65 岁)与住院时间延长(OR=2;95%CI=1.4-3)和死亡(OR=6;95%CI=3-11)相关。RT-qPCR 样本采集时间在阳性和阴性检测之间存在差异(P=0.001),4-10 天采集时间病毒检测阳性的机会更大(OR=2.9;95%CI=1.6-5)。

结论

死亡与年龄和肺部损伤有关。住院时间与年龄、高血压、肺部损伤和死亡有关。进行 RT-qPCR 和快速检测的样本采集时间与 COVID-19 阳性结果相关。这些结果强调了诊断、治疗和减轻 COVID-19 大流行影响方面持续存在的挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1408/9214823/52670775b551/gr1_lrg.jpg

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