Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
Department of Research and Development, Region Kronoberg, Vaxjo, Sweden.
BMJ Open. 2023 Apr 28;13(4):e069037. doi: 10.1136/bmjopen-2022-069037.
To explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in men and women hospitalised for COVID-19 during the first three waves of the pandemic in Sweden in comparison to previous influenza outbreaks.
A registry-based, retrospective, case-control study.
Hospital care in Sweden.
All patients in Sweden with a main hospital diagnosis of COVID-19 (January 2020-September 2021) or influenza (January 2015-December 2019) with previous CRD were identified in registries and compared with a reference group free from CRD but with COVID-19 or influenza.
Associated risk of all-cause death during the first year was analysed using adjusted Cox proportional hazards models.
In COVID-19 patients with and without prior history of CRD (n=44 866), mean age was 79.8 years (SD 11.8) and 43% were women. In influenza patients (n=8897), mean age was 80.6 years (SD 11.5) and 45% were women. COVID-19 versus influenza was associated with higher mortality risk during the first two COVID-19 waves (HR 1.53; 95% CI 1.45 to 1.62, p<0.001 and HR 1.52; 95% CI 1.44 to 1.61, p<0.001), but not in the third wave (HR 1.07; 95% CI 0.99 to 1.14, p=0.072). CRD was an independent risk factor for all-cause death after COVID-19 in men and women (men: 1.37; 95% CI 1.31 to 1.44, p<0.001; women: 1.46; 95% CI 1.38 to 1.54, p<0.001). At ages <70 years, women with CRD had a similar mortality rate to men with CRD, while at ages ≥70 years, the mortality rate was higher in men.
Outcome after COVID-19 is worse if CRD is present. In women at ages <70 years, the presence of CRD attenuates the protective effect of female sex. COVID-19 was associated with higher mortality risk than influenza during the first two pandemic waves.
探讨在瑞典 COVID-19 大流行的前三个波次期间，与既往流感暴发相比，合并或不合并心肾疾病（心衰和/或慢性肾病）的 COVID-19 住院患者的死亡率。
基于登记的回顾性病例对照研究。
瑞典医院。
所有在瑞典因 COVID-19（2020 年 1 月至 2021 年 9 月）或流感（2015 年 1 月至 2019 年 12 月）住院且有既往心肾疾病主要诊断的患者均在登记处确定，并与无心肾疾病但有 COVID-19 或流感的参考组进行比较。
采用校正后的 Cox 比例风险模型分析第一年全因死亡的风险比。
在有或无既往心肾疾病史的 COVID-19 患者（n=44866）中，平均年龄为 79.8 岁（SD 11.8），43%为女性。在流感患者（n=8897）中，平均年龄为 80.6 岁（SD 11.5），45%为女性。与流感相比，前两波 COVID-19 期间 COVID-19 与更高的死亡率相关（HR 1.53；95%CI 1.45 至 1.62，p<0.001 和 HR 1.52；95%CI 1.44 至 1.61，p<0.001），但在第三波中无相关性（HR 1.07；95%CI 0.99 至 1.14，p=0.072）。在心肾疾病患者中，无论男性还是女性，COVID-19 后全因死亡都是独立的危险因素（男性：1.37；95%CI 1.31 至 1.44，p<0.001；女性：1.46；95%CI 1.38 至 1.54，p<0.001）。在年龄<70 岁的女性中，CRD 患者的死亡率与男性相似，而在年龄≥70 岁的女性中，男性的死亡率更高。
如果存在心肾疾病，COVID-19 后的结局更差。在年龄<70 岁的女性中，CRD 的存在削弱了女性性别带来的保护作用。在头两个大流行波次期间，COVID-19 导致的死亡率高于流感。
