在一家大型都市儿童医院的 COVID-19 儿科 ICU 入院患者中，哮喘是一种合并症。
Asthma as a comorbidity in COVID-19 pediatric ICU admissions in a large metropolitan children's hospital.
机构信息
Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
出版信息
Pediatr Pulmonol. 2023 Jan;58(1):206-212. doi: 10.1002/ppul.26184. Epub 2022 Nov 2.
RATIONALE
Children contribute to 5% of coronavirus disease of 2019 (COVID-19)-related hospitalizations in the United States. There is mounting evidence suggesting childhood asthma is a risk factor for severe disease. We hypothesized that asthma is associated with longer length of stay (LOS) and need for respiratory support among children admitted to pediatric intensive care unit (PICU) with COVID-19.
METHODS
We reviewed 150 charts of children and young adults with a positive severe acute respiratory syndrome coronavirus 2polymerase chain reaction test admitted to the PICU at Children's National Hospital, Washington, DC between 2020 and 2021. We recorded demographics, anthropometrics, past medical history, clinical course, laboratory findings, imaging, medication usage, respiratory support, and outcomes. Functional Status Scale (FSS), which measures an Intensive Care Unitpatient's physical function, was used to characterize children with multiple comorbidities; FSS and obesity were included as covariates in multivariate analysis. Statistical analysis was performed using SPSS v25.0.
RESULTS
Sixty-Eight patients ages 0-21 years met inclusion criteria. Median age was 14.9 years, 55.9% were female, median Body Mass Index percentile was 62, and 42.6% were African American. Compared with those without asthma, patients with asthma averaged longer LOS (20.7 vs. 10.2 days, p = 0.02), with longer PICU stay (15.9 vs. 7.6 days, p = 0.033) and prolonged maximum respiratory support (8.3 vs. 3.3 days, p = 0.016). Adjusted for obesity and poor physical function (FSS > 6), asthma remained a significant predictor of hospital LOS, PICU LOS, and days on maximum respiratory support.
CONCLUSION
Asthma can cause severe disease with prolonged need for maximum respiratory support among children with COVID-19.
背景
在美国，儿童约占 2019 冠状病毒病（COVID-19）相关住院患者的 5%。越来越多的证据表明，儿童哮喘是重症的危险因素。我们假设哮喘与 COVID-19 患儿入住儿科重症监护病房（PICU）后的住院时间（LOS）延长和呼吸支持需求增加有关。
方法
我们回顾了 2020 年至 2021 年期间，华盛顿特区儿童国家医院收治的 150 例 SARS-CoV-2 聚合酶链反应检测呈阳性的儿童和青少年的病历。我们记录了人口统计学、人体测量学、既往病史、临床病程、实验室检查结果、影像学、药物使用、呼吸支持和结局。采用功能状态量表（FSS）评估 ICU 患者的身体功能，用于描述合并多种疾病的儿童；在多变量分析中，将 FSS 和肥胖作为协变量纳入。使用 SPSS v25.0 进行统计分析。
结果
纳入标准的 68 例患者年龄 0-21 岁。中位年龄 14.9 岁，55.9%为女性，中位数体重指数百分比为 62%，42.6%为非裔美国人。与无哮喘的患者相比，哮喘患者的 LOS 更长（20.7 天 vs. 10.2 天，p=0.02），PICU 入住时间更长（15.9 天 vs. 7.6 天，p=0.033），最大呼吸支持时间延长（8.3 天 vs. 3.3 天，p=0.016）。调整肥胖和较差的身体功能（FSS>6）后，哮喘仍然是 COVID-19 患儿住院 LOS、PICU LOS 和最大呼吸支持天数的显著预测因素。
结论
哮喘可导致 COVID-19 患儿病情严重，需要长时间的最大呼吸支持。
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