Ticinesi Andrea, Parise Alberto, Cerundolo Nicoletta, Nouvenne Antonio, Prati Beatrice, Chiussi Giulia, Guerra Angela, Meschi Tiziana
Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy.
Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy.
J Clin Med. 2022 Sep 16;11(18):5442. doi: 10.3390/jcm11185442.
The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73−88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573−0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977−0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152−2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389−6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.
本研究的目的是描述因感染新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）出现突破性感染而住院患者的特征，并确定胸部计算机断层扫描（CT）显示的肺炎相关因素及死亡率相关因素。对2021年6月至12月期间在完成初级疫苗接种周期后住院的229例患者（105例女性）的临床记录进行了回顾性分析，这些患者的年龄中位数为81岁（四分位间距，IQR，73 - 88岁），收集了合并症、临床衰弱量表（CFS）、临床表现和结局的数据。多种合并症（91.7%有≥2种慢性疾病）和衰弱（61.6%的CFS≥5）非常普遍。CFS（比值比[OR]0.678，95%置信区间[CI]0.573 - 0.803，p < 0.001）和高血压与间质性肺炎独立相关。死亡率为25.1%，且与年龄无关。入院时进行的血气分析中的动脉血氧分压/吸入氧浓度比值（PaO2/FiO2）（OR 0.986，95% CI 0.977 - 0.996，p = 0.005）和CFS（OR 1.723，95% CI 1.152 - 2.576，p = 0.008）仅在年龄<85岁的患者中与死亡率独立相关。相反，血清降钙素原（PCT）水平与年龄≥85岁患者的死亡率相关（OR 3.088，95% CI 1.389 - 6.8628，p = 0.006）。总之，因COVID-19突破性感染住院的患者主要是老年患者，年龄≥85岁者更以基线合并症失代偿为特征，而非典型的COVID-19呼吸道症状。
