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疫情头14个月期间秘鲁高海拔地区与COVID-19死亡相关的因素:一项针对住院患者的回顾性多中心队列研究

Factors Associated with COVID-19 Death in a High-Altitude Peruvian Setting during the First 14 Months of the Pandemic: A Retrospective Multicenter Cohort Study in Hospitalized Patients.

作者信息

Concha-Velasco Fátima, Moncada-Arias Ana G, Antich María K, Delgado-Flores Carolina J, Ramírez-Escobar Cesar, Ochoa-Linares Marina, Velásquez-Cuentas Lucio, Dueñas de la Cruz Homero, Loyola Steev

机构信息

Universidad Continental, Cusco 08000, Peru.

Dirección de Epidemiología e Investigación, Gerencia Regional de Salud (GERESA), Cusco 08200, Peru.

出版信息

Trop Med Infect Dis. 2023 Feb 22;8(3):133. doi: 10.3390/tropicalmed8030133.

Abstract

Risk factors for COVID-19 death in high-altitude populations have been scarcely described. This study aimed to describe risk factors for COVID-19 death in three referral hospitals located at 3399 m in Cusco, Peru, during the first 14 months of the pandemic. A retrospective multicenter cohort study was conducted. A random sample of ~50% (1225/2674) of adult hospitalized patients who died between 1 March 2020 and 30 June 2021 was identified. Of those, 977 individuals met the definition of death by COVID-19. Demographic characteristics, intensive care unit (ICU) admission, invasive respiratory support (IRS), disease severity, comorbidities, and clinical manifestation at hospital admission were assessed as risk factors using Cox proportional-hazard models. In multivariable models adjusted by age, sex, and pandemic periods, critical disease (vs. moderate) was associated with a greater risk of death (aHR: 1.27; 95%CI: 1.14-1.142), whereas ICU admission (aHR: 0.39; 95%CI: 0.27-0.56), IRS (aHR: 0.37; 95%CI: 0.26-0.54), the ratio of oxygen saturation (ROX) index ≥ 5.3 (aHR: 0.87; 95%CI: 0.80-0.94), and the ratio of SatO/FiO ≥ 122.6 (aHR: 0.96; 95%CI: 0.93-0.98) were associated with a lower risk of death. The risk factors described here may be useful in assisting decision making and resource allocation.

摘要

高海拔人群中新冠病毒疾病(COVID-19)死亡的风险因素鲜有描述。本研究旨在描述在秘鲁库斯科海拔3399米的三家转诊医院在疫情的前14个月中COVID-19死亡的风险因素。开展了一项回顾性多中心队列研究。确定了2020年3月1日至2021年6月30日期间死亡的成年住院患者中约50%(1225/2674)的随机样本。其中,977人符合COVID-19死亡的定义。使用Cox比例风险模型将人口统计学特征、重症监护病房(ICU)入院情况、有创呼吸支持(IRS)、疾病严重程度、合并症以及入院时的临床表现评估为风险因素。在根据年龄、性别和疫情时期进行调整的多变量模型中,危重型疾病(与中型相比)与更高的死亡风险相关(调整后风险比:1.27;95%置信区间:1.14 - 1.42),而ICU入院(调整后风险比:0.39;95%置信区间:0.27 - 0.56)、IRS(调整后风险比:0.37;95%置信区间:0.26 - 0.54)、氧饱和度(ROX)指数≥5.3(调整后风险比:0.87;95%置信区间:0.80 - 0.94)以及血氧饱和度/吸入氧分数(SatO/FiO)比值≥122.6(调整后风险比:0.96;95%置信区间:0.93 - 0.98)与较低的死亡风险相关。此处描述的风险因素可能有助于辅助决策和资源分配。

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