新冠肺炎住院患者的临床特征及其对死亡率的影响：宾夕法尼亚州的一项单网络回顾性队列研究
Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state.
作者信息
Gadhiya Kinjal P, Hansrivijit Panupong, Gangireddy Mounika, Goldman John D
机构信息
Department of Internal Medicine, UPMC Pinnacle, Harrisburg, Pennsylvania, USA.
Department of Infectious Diseases, UPMC Pinnacle, Harrisburg, Pennsylvania, USA.
出版信息
BMJ Open. 2021 Apr 8;11(4):e042549. doi: 10.1136/bmjopen-2020-042549. eCollection 2021.
OBJECTIVE
COVID-19 is a respiratory disease caused by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical characteristics and risk factors for in-hospital mortality from COVID-19.
DESIGN
Retrospective observational study.
SETTING
Single-network hospitals in Pennsylvania state.
PARTICIPANTS
Patients with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May 2020.
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary outcome was in-hospital mortality. Secondary outcomes were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS).
RESULTS
Of 283 patients, 19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male and 50.2% were white. Several factors were identified from our adjusted multivariate analyses to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 (1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell >10 ; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/mL (OR 2.242 (1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR 4.608-13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to 30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of in-hospital mortality.
CONCLUSION
We reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from Pennsylvania state.
目的
新型冠状病毒肺炎（COVID-19）是一种由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的呼吸道疾病，在美国负担最重。关于美国人群中COVID-19患者临床特征的数据有限。因此，我们旨在确定COVID-19患者的临床特征和院内死亡的危险因素。
设计
回顾性观察研究。
地点
宾夕法尼亚州的单网络医院。
参与者
2020年3月1日至5月31日期间住院的确诊SARS-CoV-2感染患者。
主要和次要结局指标
主要结局是院内死亡。次要结局是并发症，如急性肾损伤（AKI）和急性呼吸窘迫综合征（ARDS）。
结果
283例患者中，19.4%为非幸存者。所有患者的平均年龄为64.1±15.9岁。56.2%为男性，50.2%为白人。我们通过调整后的多变量分析确定了几个与院内死亡相关的因素：年龄增加（每增加1岁；比值比[OR]1.07[1.045至1.105]）、低氧血症（氧饱和度<95%；OR 4.630[1.934至11.111]）、影像学上的实变/浸润（OR 3.077[1.276至7.407]）、白细胞增多（白细胞>10；OR 2.732[1.412至5.263]）、铁蛋白>336 ng/mL（OR 4.016[1.195至13.514]）、乳酸脱氢酶>200 U/L（OR 7.752[1.639至37.037]）、降钙素原>0.25 ng/mL（OR 2.404[1.011至5.714]）、肌钙蛋白I>0.03 ng/mL（OR 2.242[1.080至4.673]）、除简单鼻导管外需要高级氧支持（OR 4.608 - 13.889[2.053至31.250]）、入住/转入重症监护病房（OR 13.699[6.135至30.303]）、肾脏替代治疗（OR 21.277[5.025至90.909]）、需要血管活性药物（OR 22.222[9.434至52.632]）、ARDS（OR 23.810[10.204至55.556]）、呼吸性酸中毒（OR 7.042[2.915至16.949]）和AKI（OR 3.571[1.715至7.407]）。当对危重症患者进行独立分析时，序贯器官衰竭评估评分增加（OR 1.544[1.168至2.039]）、AKI（OR 2.128[1.111至6.667]）和ARDS（OR 6.410[2.237至18.182]）可预测院内死亡。
结论
我们报告了宾夕法尼亚州不同种族的住院COVID-19患者的特征。
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