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2020年因感染新冠病毒而入院的心脏移植受者的临床结局:一项全国性分析。

Clinical Outcomes of Heart Transplant Recipients Admitted with COVID-19 Infection in 2020: A Nationwide Analysis.

作者信息

Tamimi Omar, Tamimi Faisal, Nisar Tariq, Gaber Ahmed Osama, Lin Jiejian, Gorthi Janardhana, Gotur Deepa

机构信息

Department of Medicine, Houston Methodist Hospital, Houston, TX.

Department of Medicine, Jamaica Medical Center, Queens, NY.

出版信息

Curr Probl Cardiol. 2023 Dec;48(12):101996. doi: 10.1016/j.cpcardiol.2023.101996. Epub 2023 Jul 26.

DOI:10.1016/j.cpcardiol.2023.101996
PMID:37506956
Abstract

The COVID-19 pandemic, caused by infection of the SARS-CoV-2 virus, has impacted morbidity and mortality through widespread cytokine release and aberrant immunity; the mainstay of management has been immunosuppression. The aim of our retrospective study is to determine the effects of solid-organ transplantation (SOT) on COVID-19 admissions using data from the 2020 nationwide inpatient sample (NIS). After multivariate adjustment, we found COVID-19 admission with SOT had no difference in mortality (11.5% vs 11.1%, adjusted OR: 0.99 [95% CI 0.84-1.19, P = 0.99], no difference in need for vasopressor use (2.6% vs 1.8%, adjusted OR: 1.02 [95% CI 0.73-1.44, P = 0.88]), lower odds of requiring mechanical ventilation (MV) (13.7% vs 14.8%, adjusted OR: 0.83 [95% CI 0.71-0.97, P = 0.02]), lower odds of MV within 24 hours of admission (adjusted OR: 0.60 [95% CI 0.47-0.78, P < 0.01]), increased odds of mechanical circulatory support needs (adjusted OR 3.7 [95% CI 1.2-11.7, P = 0.025]), increased odds of acute renal failure requiring renal replacement therapy (adjusted OR 1.66 [95% CI 1.29-2.15, P < 0.01]), decreased mean length of stay (7.45 days vs 7.48 days, adjusted difference: 0.8 days less, P <0.01), and no difference in mean total hospitalization charges ($91,316 vs $79,100, adjusted difference: -$2,667, P = 0.57) compared to COVID-19 admissions without SOT.

摘要

由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)病毒感染引起的2019冠状病毒病(COVID-19)大流行,通过广泛的细胞因子释放和异常免疫影响发病率和死亡率;治疗的主要手段一直是免疫抑制。我们这项回顾性研究的目的是利用2020年全国住院患者样本(NIS)的数据,确定实体器官移植(SOT)对COVID-19住院患者的影响。经过多变量调整后,我们发现接受SOT的COVID-19住院患者在死亡率方面没有差异(11.5%对11.1%,调整后的比值比:0.99[95%置信区间0.84-1.19,P = 0.99]),在使用血管加压药的需求方面没有差异(2.6%对1.8%,调整后的比值比:1.02[95%置信区间0.73-1.44,P = 0.88]),需要机械通气(MV)的几率较低(13.7%对14.8%,调整后的比值比:0.83[95%置信区间0.71-0.97,P = 0.02]),入院24小时内进行MV的几率较低(调整后的比值比:0.60[95%置信区间0.47-0.78,P < 0.01]),需要机械循环支持的几率增加(调整后的比值比3.7[95%置信区间1.2-11.7,P = 0.025]),需要肾脏替代治疗的急性肾衰竭几率增加(调整后的比值比1.66[95%置信区间1.29-2.15,P < 0.01]),平均住院时间缩短(7.45天对7.48天,调整后的差异:少0.8天,P < 0.01),与未接受SOT的COVID-19住院患者相比,平均总住院费用没有差异(91,316美元对79,100美元,调整后的差异:-2,667美元,P = 0.

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