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2020/2021年德国第二波新冠疫情期间一家重症监护医院收治的感染SARS-CoV-2老年住院患者的预后及死亡风险因素

[Risk factors for outcome and mortality in hospitalized geriatric patients with SARS-CoV-2 infection : Data from a hospital of maximum care during in the period of the second corona wave 2020/2021 in Germany].

作者信息

Dörr Stefan, Joachim Regina, Chatzitomaris Apostolos, Lobmann Ralf

机构信息

Krankenhaus Bad Cannstatt, Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum der Landeshauptstadt Stuttgart gKAöR, Prießnitzweg 24, 70374, Stuttgart, Deutschland.

出版信息

Z Gerontol Geriatr. 2023 Mar;56(2):118-124. doi: 10.1007/s00391-023-02161-8. Epub 2023 Feb 7.

Abstract

BACKGROUND

From autumn 2020 until spring 2021 Germany experienced the second wave of SARS-CoV‑2 infections. As in the previous wave, the older population in nursing homes was hard hit by this infection because of the lack of available vaccines. Due to the multimorbidity in this susceptible group the mortality was high.

METHODS

Retrospectively collected patient data of geriatric patients treated from 1 October 2020 to 31 March 2021 due to proven SARS-CoV‑2 infection were evaluated concerning the duration of symptoms, hospital stay, and laboratory results. The results are presented descriptively and significance tests were performed with t‑test and log-rank test to reveal some risk factors for a worse outcome.

RESULTS

A total of 168 patients aged from 65 to 97 years were included, with a mean mortality rate of 28% and was highest in the age group over 90 years old. Most patients died within the first 10 days of hospitalization. Intensive care treatment prolonged the hospital stay by 6 days, but the average survival time became equal at the end. Risk factors for worse outcome and the need of intensive care treatment were neutrophilia, lymphopenia, high levels of ferritin and high D‑dimer levels on the day of admission. Age, short duration of symptoms and pre-existing dementia, administration of neuroleptic drugs and antidepressants increased the risk of death.

摘要

背景

从2020年秋季到2021年春季,德国经历了严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的第二波疫情。与前一波疫情一样,由于缺乏可用疫苗,养老院中的老年人群受到此次感染的严重冲击。由于这一易感人群存在多种疾病,死亡率很高。

方法

回顾性收集2020年10月1日至2021年3月31日因确诊SARS-CoV-2感染而接受治疗的老年患者的资料,评估症状持续时间、住院时间和实验室检查结果。结果以描述性方式呈现,并采用t检验和对数秩检验进行显著性检验,以揭示一些导致预后较差的危险因素。

结果

共纳入168例年龄在65至97岁之间的患者,平均死亡率为28%,90岁以上年龄组的死亡率最高。大多数患者在住院的前10天内死亡。重症监护治疗使住院时间延长了6天,但最终平均生存时间相同。入院当天中性粒细胞增多、淋巴细胞减少、铁蛋白水平升高和D-二聚体水平升高是预后较差和需要重症监护治疗的危险因素。年龄、症状持续时间短、既往有痴呆症、使用抗精神病药物和抗抑郁药会增加死亡风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6d37/9903262/5432af293080/391_2023_2161_Fig1_HTML.jpg

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