Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States.
David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States.
EBioMedicine. 2022 Sep;83:104208. doi: 10.1016/j.ebiom.2022.104208. Epub 2022 Aug 8.
Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.
Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.
The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.
Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.
NIH.
为了进一步改善患者管理，需要更好地了解因感染 2019 年冠状病毒病（COVID-19）而住院的患者的特征与预后之间的关系。
冠状病毒病 19 免疫表型评估队列研究（IMPACC）是一项在美国 20 家医院进行的前瞻性观察性研究，共纳入 1164 例患者。使用基于呼吸疾病严重程度的 7 分序数量表评估疾病严重程度。出院后 1 年，通过每季度进行一次调查，前瞻性地调查 COVID-19 的急性后遗症（PASC）。在 28 天内采集患者的人口统计学、合并症、影像学表现、临床实验室值、SARS-CoV-2 PCR 和血清学数据。采用多变量逻辑回归进行分析。
中位年龄为 59 岁（四分位距[IQR] 20）；711 例（61%）为男性；总体死亡率为 14%，228 例（20%）需要有创机械通气。对时间上的序数量表进行无监督聚类，发现了不同的疾病进展轨迹。与第 28 天住院时间延长或死亡相关的危险因素包括年龄≥65 岁（比值比[OR]，2.01；95%置信区间[CI]，1.28-3.17）、西班牙裔（OR，1.71；95%CI，1.13-2.57）、基线肌酐（OR，2.80；95%CI，1.63-4.80）或肌钙蛋白（OR，1.89；95%CI，1.03-3.47）升高、基线淋巴细胞减少（OR，2.19；95%CI，1.61-2.97）、胸部影像学存在浸润影（OR，3.16；95%CI，1.96-5.10）和高 SARS-CoV-2 病毒载量（OR，1.53；95%CI，1.17-2.00）。死亡病例的 SARS-CoV-2 抗体与病毒载量比值与其他轨迹相比在整个时间内最低（p=0.001）。589 例存活者（51%）完成了至少一次随访调查，其中 305 例（52%）至少有 1 种符合 PASC 的症状，最常见的是呼吸困难（56%的有症状患者）。女性是 PASC 的唯一相关危险因素。
PCR 循环阈值和抗体值与人口统计学、合并症和实验室/影像学表现相结合，确定了 28 天预后严重程度的危险因素，但只有女性与 PASC 相关。纵向临床表型分析提供了重要的见解，并为急性和长期 COVID-19 的免疫表型分析提供了框架。
美国国立卫生研究院。
