Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Cardiology Division, Stanford University, Stanford, CA.
Veterans Affairs Medical Center, Washington, DC; Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ.
Mayo Clin Proc. 2024 Nov;99(11):1744-1755. doi: 10.1016/j.mayocp.2024.07.004. Epub 2024 Sep 7.
To assess the association between cardiorespiratory fitness (CRF) and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation.
In a retrospective analysis of 750,302 patients included in the Exercise Testing and Health Outcomes Study, we identified 23,140 who had a positive result on COVID-19 testing between March 2020 and September 2021 and underwent a maximal exercise test in the Veterans Affairs Health Care System between October 1, 1999 to September 3, 2020. The association between CRF and risk for severe COVID-19 outcomes, including mortality, hospitalization due to COVID-19, and need for intubation was assessed after adjustment for 15 covariates. Patients were stratified into 5 age-specific CRF categories (Least-Fit, Low-Fit, Moderate-Fit, Fit, and High-Fit), based on peak metabolic equivalents achieved.
During a median of follow-up of 100 days, 1643 of the 23,140 patients (7.1%) died, 4995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19-related reasons. When compared with the Least-Fit patients (referent), the Low-Fit, Moderate-Fit, Fit, and High-Fit patients had hazard ratios for mortality of 0.82 (95% CI, 0.72 to 0.93), 0.73 (95% CI, 0.63 to 0.86), 0.61 (95% CI, 0.53 to 0.72), and 0.54 (95% CI, 0.45 to 0.65), respectively. Patients who were more fit also had substantially lower need for hospital admissions and intubation. Similar patterns were observed for elderly patients and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category.
Among patients positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, body mass index, or the presence of comorbidities.
评估心肺适能（CRF）与 COVID-19 相关健康结局之间的关联，包括死亡率、住院率和机械通气。
在对纳入运动测试和健康结局研究的 750302 例患者的回顾性分析中，我们确定了 23140 例 2020 年 3 月至 2021 年 9 月间 COVID-19 检测呈阳性并在退伍军人事务医疗保健系统中于 1999 年 10 月 1 日至 2020 年 9 月 3 日期间进行了最大运动测试的患者。在调整了 15 个协变量后，评估了 CRF 与严重 COVID-19 结局（包括死亡率、因 COVID-19 住院和需要插管）风险之间的关联。根据达到的峰值代谢当量，患者被分为 5 个年龄特异性 CRF 类别（最不适、低适、中适、适和高适）。
在中位数为 100 天的随访期间，23140 例患者中有 1643 例（7.1%）死亡，4995 例（21.6%）因 COVID-19 住院，927 例（4.0%）因 COVID-19 相关原因需要插管。与最不适的患者（参考）相比，低适、中适、适和高适的患者的死亡率的危险比分别为 0.82（95%CI，0.72 至 0.93）、0.73（95%CI，0.63 至 0.86）、0.61（95%CI，0.53 至 0.72）和 0.54（95%CI，0.45 至 0.65）。身体更健康的患者也有更低的住院和插管需求。在老年患者和伴有高血压、糖尿病、心血管疾病和慢性肾病等合并症的亚组中观察到了类似的模式；对于这些情况中的每一种，高适类别的死亡率大约是低适类别的一半。
在 COVID-19 检测呈阳性的患者中，无论年龄、体重指数或是否存在合并症，更高的 CRF 对生存、住院需求和插管需求都有有利影响。
