Leding Cæcilie, Clausen Clara Lundetoft, Roldgaard Marcus Sebastian, Benfield Thomas
Department of Infectious Diseases, Center of Research & Disruption of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Infect Dis (Lond). 2024 Jan;56(1):42-51. doi: 10.1080/23744235.2023.2267134. Epub 2023 Dec 18.
Mortality rates peaked early in the COVID-19 pandemic and then declined. Possible explanations are pharmacological and non-pharmacological treatments, vaccines and changing demographics. We sought to evaluate temporal trends in clinical characteristics and survival of patients hospitalised with COVID-19 during the first two years of the pandemic in Denmark.
In this observational study, we included all adults with COVID-19 consecutively admitted to three hospitals in Copenhagen, Denmark, from March 2020 through March 2022. The primary outcome was overall survival up to day 90 from admission. We used multivariable Cox proportional hazards models to estimate the association of survival within five consecutive time-periods, based on admission date, adjusted for baseline characteristics, vaccination status, remdesivir and dexamethasone treatment.
In 1630 included patients, the median age [IQR] was 68 [52, 79] years, 56.6% were men and 86.2% had comorbidity. Clinical characteristics changed over time. The crude 90-day mortality rate peaked in March-June 2020 with 28.9%, decreased from July 2020 to 17.5%, and increased again in January-March 2022 to 28.6%. Lower hazard ratios for death were observed in individuals admitted from July 2020 and persisted after adjusting for baseline characteristics. Adjusting for vaccination, remdesivir treatment and dexamethasone treatment attenuated the association in patients requiring low-flow oxygen.
Our study suggests lower hazard rates for mortality in patients hospitalised with COVID-19 from July 2020 compared to March-June 2020, mainly driven by lower mortality in patients with a need of oxygen at baseline.
在新冠疫情早期死亡率达到峰值，随后下降。可能的解释包括药物和非药物治疗、疫苗以及人口结构变化。我们试图评估丹麦疫情头两年因新冠住院患者的临床特征和生存的时间趋势。
在这项观察性研究中，我们纳入了2020年3月至2022年3月期间连续入住丹麦哥本哈根三家医院的所有成年新冠患者。主要结局是入院后90天的总体生存率。我们使用多变量Cox比例风险模型，根据入院日期估计连续五个时间段内生存的关联，并对基线特征、疫苗接种状况、瑞德西韦和地塞米松治疗进行了调整。
在纳入的1630例患者中，年龄中位数[四分位间距]为68[52,79]岁，56.6%为男性，86.2%有合并症。临床特征随时间变化。2020年3月至6月粗90天死亡率达到峰值，为28.9%，从2020年7月降至17.5%，并在2022年1月至3月再次升至28.6%。2020年7月入院的个体死亡风险比更低，在调整基线特征后仍然存在。对疫苗接种、瑞德西韦治疗和地塞米松治疗进行调整后，降低了低流量吸氧患者的关联。
我们的研究表明，与2020年3月至6月相比，2020年7月因新冠住院患者的死亡风险率更低，主要是由于基线时需要吸氧的患者死亡率较低。
