Mitsushima Shingo, Horiguchi Hiromasa, Taniguchi Kiyosu
Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan.
Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Meguro-ku, Tokyo, Japan.
Int J Gen Med. 2023 Feb 21;16:657-672. doi: 10.2147/IJGM.S394413. eCollection 2023.
Results of earlier studies have demonstrated underlying diseases such as cancer, diabetes mellitus, immunodeficiency, hypertension and heart failure to be risk factors for severe outcomes and mortality. Furthermore, clinical trials have shown that drugs such as antiviral drugs, antibody cocktails, steroids and anti-inflammatory drugs can be expected to prevent severe COVID-19 outcomes and death.
This study, using inpatient records from the Medical Information Analysis Databank covering national hospital organizations in Japan, was conducted to evaluate the effects of underlying diseases and/or administered drugs on mortality. Subjects were all inpatients receiving oxygen administration and inpatients using respiratory ventilators, categorized by three age classes: all ages, patients 65 years old or older, and patients younger than 65 years old. We used logistic regression to analyze outcomes for underlying diseases, administered drugs, age, sex, the proportion of the mutated strains, and vaccine coverage.
Patients with hypertension, except for younger inpatients, have a lower risk of mortality (estimated coefficient 0.67 among all inpatients ( < 0.01): 0.77 among inpatients with oxygen therapy ( = 0.02) and 0.57 among inpatients with respiratory ventilation w ( = 0.01)). Except for younger inpatients, antibody cocktail (casirivimab/imdevimab or sotrovimab) administration was associated with a higher probability of survival (estimated coefficient 0.27 among all inpatients ( < 0.01)). It raised the survival probability consistently, although other drugs might have reduced the probability of survival.
These findings suggest that antiviral drugs (remdesivir, estimated coefficient 1.44 ( < 0.01)), steroids (dexamethasone, estimated coefficient 1.85 ( < 0.01)), and anti-inflammatory drugs (baricitinib, estimated coefficient 1.62 ( < 0.01), and tocilizumab, estimated coefficient 2.73 ( < 0.01)) might not contribute to survival. These results have not been reported from earlier studies. More sophisticated estimation procedures, such as treatment effect models, are necessary to obtain conclusive results.
早期研究结果表明，癌症、糖尿病、免疫缺陷、高血压和心力衰竭等基础疾病是导致严重后果和死亡的风险因素。此外，临床试验表明，抗病毒药物、抗体鸡尾酒、类固醇和抗炎药物等有望预防严重的 COVID-19 后果和死亡。
本研究利用覆盖日本全国医院组织的医疗信息分析数据库中的住院记录，评估基础疾病和/或所用药物对死亡率的影响。研究对象为所有接受氧气治疗的住院患者以及使用呼吸呼吸机的住院患者，按三个年龄组分类：所有年龄段、65 岁及以上患者和 65 岁以下患者。我们使用逻辑回归分析基础疾病、所用药物、年龄、性别、变异毒株比例和疫苗接种率的结果。
除年轻住院患者外，高血压患者的死亡风险较低（所有住院患者中的估计系数为 0.67（<0.01）：接受氧疗的住院患者中为 0.77（=0.02），接受呼吸通气的住院患者中为 0.57（=0.01））。除年轻住院患者外，使用抗体鸡尾酒（卡西瑞韦单抗/英地西单抗或索托维单抗）与更高的生存概率相关（所有住院患者中的估计系数为 0.27（<0.01））。尽管其他药物可能降低了生存概率，但它持续提高了生存概率。
这些发现表明，抗病毒药物（瑞德西韦，估计系数 1.44（<0.01））、类固醇（地塞米松，估计系数 1.85（<0.01））和抗炎药物（巴瑞替尼，估计系数 1.62（<0.01），托珠单抗，估计系数 2.73（<0.01））可能无助于生存。早期研究尚未报道这些结果。需要更复杂的估计程序，如治疗效果模型，以获得确凿的结果。
