Gatto Nicole M, Freund Debbie, Ogata Pamela, Diaz Lisa, Ibarrola Ace, Desai Mamta, Aspelund Thor, Gluckstein Daniel
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
School of Public Health, Loma Linda University, Loma Linda, California, USA.
Open Forum Infect Dis. 2023 Jan 10;10(1):ofad011. doi: 10.1093/ofid/ofad011. eCollection 2023 Jan.
Studies of inpatient coronavirus disease 2019 (COVID-19) mortality risk factors have mainly used data from academic medical centers or large multihospital databases and have not examined populations with large proportions of Hispanic/Latino patients. In a retrospective cohort study of 4881 consecutive adult COVID-19 hospitalizations at a single community hospital in Los Angeles County with a majority Hispanic/Latino population, we evaluated factors associated with mortality.
Data on demographic characteristics, comorbidities, laboratory and clinical results, and COVID-19 therapeutics were abstracted from the electronic medical record. Cox proportional hazards regression modeled statistically significant, independently associated predictors of hospital mortality.
Age ≥65 years (hazard ratio [HR] = 2.66; 95% confidence interval [CI] = 1.90-3.72), male sex (HR = 1.31; 95% CI = 1.07-1.60), renal disease (HR = 1.52; 95% CI = 1.18-1.95), cardiovascular disease (HR = 1.45; 95% CI = 1.18-1.78), neurological disease (HR = 1.84; 95% CI = 1.41-2.39), D-dimer ≥500 ng/mL (HR = 2.07; 95% CI = 1.43-3.0), and pulse oxygen level <88% (HR = 1.39; 95% CI = 1.13-1.71) were independently associated with increased mortality. Patient household with (1) multiple COVID-19 cases and (2) Asian, Black, or Hispanic compared with White non-Hispanic race/ethnicity were associated with reduced mortality. In hypoxic COVID-19 inpatients, remdesivir, tocilizumab, and convalescent plasma were associated with reduced mortality, and corticosteroid use was associated with increased mortality.
We corroborate several previously identified mortality risk factors and find evidence that the combination of factors associated with mortality differ between populations.
关于2019冠状病毒病（COVID-19）住院患者死亡风险因素的研究主要使用了学术医疗中心或大型多医院数据库的数据，尚未对西班牙裔/拉丁裔患者比例较大的人群进行研究。在一项对洛杉矶县一家单一社区医院连续收治的4881例成年COVID-19住院患者进行的回顾性队列研究中，我们评估了与死亡率相关的因素，该社区医院的患者以西班牙裔/拉丁裔为主。
从电子病历中提取人口统计学特征、合并症、实验室和临床结果以及COVID-19治疗方法的数据。Cox比例风险回归模型确定了具有统计学意义的、与医院死亡率独立相关的预测因素。
年龄≥65岁（风险比[HR]=2.66；95%置信区间[CI]=1.90-3.72）、男性（HR=1.31；95%CI=1.07-1.60）、肾病（HR=1.52；95%CI=1.18-1.95）、心血管疾病（HR=1.45；95%CI=1.18-1.78）、神经系统疾病（HR=1.84；95%CI=1.41-2.39）、D-二聚体≥500 ng/mL（HR=2.07；95%CI=1.43-3.0）以及脉搏血氧水平<88%（HR=1.39；95%CI=1.13-1.71）与死亡率增加独立相关。与白人非西班牙裔种族/族裔相比，患者家庭中有（1）多例COVID-19病例以及（2）亚洲、黑人或西班牙裔与死亡率降低相关。在缺氧的COVID-19住院患者中，瑞德西韦、托珠单抗和恢复期血浆与死亡率降低相关，而使用皮质类固醇与死亡率增加相关。
我们证实了一些先前确定的死亡风险因素，并发现有证据表明不同人群中与死亡相关的因素组合有所不同。
