新冠病毒肺炎患者血栓形成并发症后继发感染的高风险
High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19.
作者信息
Ripa Marco, Galli Laura, D'Angelo Armando, Apruzzi Luca, Palumbo Diego, Campochiaro Corrado, Tassan Din Chiara, Danise Anna, Da Prat Valentina, Vitali Giordano, Brugliera Luigia, Poli Andrea, Monardo Roberta, Monti Giacomo, Baccellieri Domenico, De Cobelli Francesco, Clementi Massimo, Iannaccone Sandro, Dagna Lorenzo, Rovere-Querini Patrizia, Ciceri Fabio, Tresoldi Moreno, Zangrillo Alberto, Scarpellini Paolo, Castagna Antonella
机构信息
Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
出版信息
Open Forum Infect Dis. 2022 Sep 2;9(9):ofac454. doi: 10.1093/ofid/ofac454. eCollection 2022 Sep.
BACKGROUND
This study's primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications.
METHODS
This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray's method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections.
RESULTS
Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8-11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7-21.0) and 9.3 (95% CI, 7.9-11.0) per 1000-PDFU, respectively ( = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018-3.140; = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications.
CONCLUSIONS
In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections.
背景
本研究的主要目的是评估血栓形成并发症对继发感染发生的影响。次要目的是比较有和没有血栓形成并发症的患者继发感染的病因。
方法
这是一项队列研究（NCT04318366），研究对象为2020年2月25日至6月30日在IRCCS圣拉斐尔医院住院的2019冠状病毒病（COVID-19）患者。发病率（IR）通过单变量泊松回归计算，即每1000人日随访（PDFU）的病例数，并给出95%置信区间。采用Gray法比较有血栓形成并发症和无血栓形成并发症患者继发感染的累积发病率函数，并考虑死亡的竞争风险。应用多变量Fine-Gray模型评估与继发感染风险相关的因素。
结果
总体而言，109/904例患者发生了176例继发感染（IR为10.0；95%CI为8.8-11.5；每1000-PDFU）。有或无血栓形成并发症患者的继发感染IR分别为每1000-PDFU 15.0（95%CI为10.7-21.0）和9.3（95%CI为7.9-11.0）（P=0.017）。多变量分析显示，血栓形成并发症与继发感染的发生相关（亚分布风险比为1.788；95%CI为1.018-3.140；P=0.043）。有和没有血栓形成并发症的患者继发感染的病因相似。
结论
在COVID-19患者中，血栓形成并发症与继发感染的高风险相关。
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