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西班牙因新冠肺炎住院的慢性阻塞性肺疾病患者:第一波与第二波的比较

[Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave].

作者信息

Gómez-Antúnez M, Muiño-Míguez A, Bacete-Cebrián M, Rubio-Rivas M, Lebrón Ramos J M, de Cossío Tejido S, Peris-García J, López-Caleya J F, Casas-Rojo J M, Millán Núñez-Cortés J

机构信息

Hospital General Universitario Gregorio Marañón, Madrid, España.

Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.

出版信息

Rev Clin Esp. 2023 May;223(5):298-309. doi: 10.1016/j.rce.2023.02.003. Epub 2023 Mar 27.

Abstract

OBJECTIVE

This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave.

MATERIAL AND METHODS

This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed.

RESULTS

Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 ( = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, < 0.05), and radiological condensation (46% vs 31%, < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy.

CONCLUSIONS

Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

摘要

目的

本研究旨在比较西班牙第一波新冠疫情期间因新冠肺炎住院的慢性阻塞性肺疾病(COPD)患者与第二波疫情期间患者的特征、病情进展及预后情况。

材料与方法

这是一项对西班牙住院且被诊断为COPD并纳入SEMI-COVID-19登记系统的患者进行的观察性研究。比较了第一波(2020年3月至6月)与第二波(2020年7月至12月)因COPD住院患者的病史、症状、分析及影像学结果、治疗及病情进展。分析了与预后不良相关的因素,预后不良定义为全因死亡率以及包括死亡率、高流量氧疗、机械通气和入住重症监护病房在内的综合终点指标。

结果

在SEMI-COVID-19登记系统的21642例患者中,6.9%被诊断为COPD:第一波中有1128例(6.8%),第二波中有374例(7.7%)(P = 0.04)。与第一波患者相比,第二波患者出现干咳、发热和呼吸困难、低氧血症(43%对36%,P < 0.05)及影像学实变(46%对31%,P < 0.05)的情况较少。第二波的死亡率较低(35%对28.6%,P = 0.01)。在总样本中,接受吸入治疗的患者死亡率及预后不良的综合结局较低。

结论

第二波因新冠肺炎住院的COPD患者呼吸衰竭及影像学受累情况较少,预后较好。若没有禁忌证,这些患者应接受支气管扩张剂治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fdd/10040358/f9f54761b9d6/gr1_lrg.jpg

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