Giesing William, Soney Hywel, Wang Lucas, Hoang Lawrence, Cui Mingyang, Prathivada Sri, Sidhu Manavjot
Department of Internal Medicine, Methodist Dallas Medical Center, Dallas, TX, USA.
Department of Internal Medicine, Methodist Dallas Medical Center, Dallas, TX, USA.
Heart Lung Circ. 2024 Dec;33(12):1688-1692. doi: 10.1016/j.hlc.2023.10.023. Epub 2024 Jul 14.
Hypoxia is a common complication seen in people with COVID-19 and can often be the presenting symptom.
Using a multi-centre observational database, we analysed 3,624 hospitalised COVID-19 PCR-positive patients at Methodist Health System, Dallas, Texas, USA from March 2020 to December 2020. We compared in-hospital death or hospice referral rates and major adverse cardiovascular events (MACE) between patients with four levels of oxygen (O) requirements (0-1 L/min, 2-10 L/min, 11-20 L/min, 21-100 L/min). MACE included congestive heart failure (CHF) exacerbations, myocardial infarctions (MI), strokes, pulmonary embolism (PE) / deep venous thrombosis (DVT), and shock. Logistic regression analysis was used to determine comorbidities and demographics associated with mortality. Multinomial regression analysis was used to find which of these variables were associated with hypoxia.
Patients who arrived needing 0-1 L/min of O had reduced risk of mortality compared to those requiring 2-10 L/min (OR=1.54, 95% CI=1.207-1.976, p<0.0001), 11-20 L/min (OR=4.55, 95% CI=3.169-6.547, p<0.0001), or 21-100 L/min (OR=12.06, 95% CI=8.548-17.016, p<0.0001). In addition, patients who arrived needing 0-1 L/min of O showed reduced risk of MACE compared to those requiring 2-10 L/min (OR=1.20, 95% CI=1.029-1.409, p<0.0001), 11-20 L/min (OR=2.76, 95% CI 2.06-3.696, p<0.0001), or 21-100 L/min (OR=6.74, 95% CI 4.966-9.155, p<0.0001).
Hypoxia on arrival is associated with a significantly increased risk of mortality and MACE among hospitalised patients with COVID-19. This data will promote better prognostication and help reduce negative outcomes in an inpatient setting.
缺氧是新型冠状病毒肺炎患者常见的并发症，且常常是首发症状。
利用一个多中心观察数据库，我们分析了2020年3月至2020年12月在美国得克萨斯州达拉斯卫理公会医疗系统住院的3624例新型冠状病毒肺炎核酸检测呈阳性的患者。我们比较了四个吸氧（O）需求水平（0 - 1升/分钟、2 - 10升/分钟、11 - 20升/分钟、21 - 100升/分钟）患者的院内死亡或临终关怀转诊率以及主要不良心血管事件（MACE）。MACE包括充血性心力衰竭（CHF）加重、心肌梗死（MI）、中风、肺栓塞（PE）/深静脉血栓形成（DVT）和休克。采用逻辑回归分析来确定与死亡率相关的合并症和人口统计学特征。采用多项回归分析来找出这些变量中哪些与缺氧相关。
与需要2 - 10升/分钟吸氧的患者相比，入院时需要0 - 1升/分钟吸氧的患者死亡风险降低（比值比[OR]=1.54，95%置信区间[CI]=1.207 - 1.976，p<0.0001），与需要11 - 20升/分钟吸氧的患者相比（OR=4.55，95% CI=3.169 - 6.547，p<0.0001），以及与需要21 - 100升/分钟吸氧的患者相比（OR=12.06，95% CI=8.548 - 17.016，p<0.0001）。此外，入院时需要0 - 1升/分钟吸氧的患者与需要2 - 10升/分钟吸氧的患者相比，发生MACE的风险降低（OR=1.20，95% CI=1.029 - 1.409，p<0.0001），与需要11 - 20升/分钟吸氧的患者相比（OR=2.76，95% CI 2.06 - 3.696，p<0.0001），以及与需要21 - 100升/分钟吸氧的患者相比（OR=6.74，95% CI 4.966 - 9.155，p<0.0001）。
入院时缺氧与新型冠状病毒肺炎住院患者的死亡风险和MACE显著增加相关。这些数据将有助于更好地进行预后评估，并有助于减少住院患者的不良结局。
