Kämpe Johanna, Bohlin Olof, Jonsson Martin, Hofmann Robin, Hollenberg Jacob, Wahlin Rebecka Rubenson, Svensson Per, Nordberg Per
Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, 11883, Stockholm, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 11883, Stockholm, Sweden.
Ann Intensive Care. 2023 Apr 25;13(1):31. doi: 10.1186/s13613-023-01127-8.
Factors associated with severe COVID-19 and death among young adults are not fully understood, including differences between the sexes. The aim of this study was to identify factors associated with severe COVID-19 requiring intensive care and 90-day mortality among women and men below 50 years of age.
A register-based study using data from mandatory national registers, where patients with severe COVID-19 admitted to the ICU with need for mechanical ventilation (cases) between March 2020 and June 2021 were matched regarding age, sex, and district of residence with 10 population-based controls. Both the study population and the controls were divided into groups based on age (< 50 years, 50-64, and ≥ 65 years) and sex. Multivariate logistic regression models including socioeconomic factors were used to calculate odds ratios (OR) with 95% confidence intervals (CIs) for associations between severe COVID-19 in the population to compare the magnitude of the risk associations for co-morbidities in the different age categories, and subsequently factors associated with 90-day mortality among patients admitted to ICU.
In total, 4921 cases and 49,210 controls (median age 63 years, 71% men) were included. The co-morbidities with the strongest associations with severe COVID-19 for the young population compared to older patients were chronic kidney disease (OR 6.80 [3.61-12.83]), type 2 diabetes (OR 6.31 [4.48-8.88]), hypertension (OR 5.09 [3.79-6.84]), rheumatoid arthritis (OR 4.76 [2.29-9.89]), obesity (OR 3.76 [2.88-4.92]), heart failure (OR 3.06 [1.36-6.89]), and asthma (OR 3.04 [2.22-4.16]). When comparing women vs. men < 50 years of age, stronger associations were seen for women regarding type 2 diabetes (OR 11.25 [6.00-21.08] vs OR 4.97 [3.25-7.60]) and hypertension (OR 8.76 [5.10-15.01] vs OR 4.09 [2.86-5.86]). The factors associated with 90-day mortality in the young were previous venous thromboembolism (OR 5.50 [2.13-14.22]), chronic kidney disease (OR 4.40 [1.64-11.78]) and type 2 diabetes (OR 2.71 [1.39-5.29]). These associations with 90-day mortality were foremost driven by the female population.
Chronic kidney failure, type 2 diabetes, hypertension, rheumatoid arthritis, obesity, heart failure, and asthma were the strongest risk factors associated with severe COVID-19 requiring ICU-care in individuals < 50 years compared to the older population. However, after ICU admission, previous thromboembolism, chronic kidney failure, and type 2 diabetes were associated with increased 90-day mortality. The risk associations for co-morbidities were generally stronger among younger individuals compared to older and in women compared to men.
年轻人中与重症 COVID-19 和死亡相关的因素尚未完全明确，包括性别差异。本研究的目的是确定 50 岁以下男性和女性中与需要重症监护的重症 COVID-19 及 90 天死亡率相关的因素。
一项基于登记册的研究，使用来自国家强制登记册的数据，将 2020 年 3 月至 2021 年 6 月期间因需要机械通气而入住重症监护病房（ICU）的重症 COVID-19 患者（病例），按照年龄、性别和居住地区与 10 名基于人群的对照进行匹配。研究人群和对照均根据年龄（<50 岁、50 - 64 岁和≥65 岁）和性别进行分组。使用包括社会经济因素的多变量逻辑回归模型计算比值比（OR）及 95%置信区间（CI），以分析人群中重症 COVID-19 之间的关联，比较不同年龄类别中合并症风险关联的大小，随后分析入住 ICU 患者中与 90 天死亡率相关的因素。
共纳入 4921 例病例和 49210 名对照（中位年龄 63 岁，71%为男性）。与老年患者相比，年轻人群中与重症 COVID-19 关联最强的合并症为慢性肾脏病（OR 6.80 [3.61 - 12.83]）、2 型糖尿病（OR 6.31 [4.48 - 8.88]）、高血压（OR 5.09 [3.79 - 6.84]）、类风湿关节炎（OR 4.
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