新冠病毒住院患者再次感染、复发及再次入院的发生率和危险因素；一项全国队列研究。
Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study.
作者信息
Taherpour Niloufar, Etemad Koorosh, Mokhayeri Yaser, Fallah Saeid, Sotoodeh Ghorbani Sahar, Izadi Neda, Rahimi Elham, Shahbazi Fatemeh, Seifi Arash, Mehri Ahmad, Feyzi Rezvan, Farhadi-Babadi Kosar, Hashemi Nazari Seyed Saeed
机构信息
Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Arch Acad Emerg Med. 2024 Jun 22;12(1):e55. doi: 10.22037/aaem.v12i1.2327. eCollection 2024.
INTRODUCTION
Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran.
METHODS
This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome.
RESULTS
After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively.
CONCLUSION
Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.
引言
在新冠疫情期间，新冠病毒再次感染和因新冠病毒感染而再次入院的情况较为严重且成本高昂。本研究旨在通过分析伊朗的国家数据登记处，评估新冠病毒再次感染、复发以及再次入院的发生率和风险因素。
方法
本研究为回顾性队列研究，时间跨度从2020年3月至2021年5月。采用普查方法，纳入了从伊朗卫生和医学教育部的国家医疗保健监测中心（MCMC）数据库中获取的所有可能信息；数据包括所有确诊新冠病毒感染患者的信息，这些患者均因新冠病毒感染住院，并通过至少一次鼻咽拭子标本的聚合酶链反应（PCR）检测呈阳性而确诊。进行单因素和多因素Cox回归分析，以评估与每个研究结局相关的因素。
结果
在分析了伊朗1445441例因新冠病毒感染住院患者的数据后，住院患者中总体再次感染、初次感染至少90天后发生的再次感染、复发以及再次入院的发生率分别为每1000人年67.79例、26.8例、41.61例和30.53例。在所有住院再次感染病例（48292例）中，38.61%发生在初次感染新冠病毒90天之后。与第一波感染新冠病毒相比，在第五波感染新冠病毒（P<0.001）、患有癌症（P<0.001）、慢性肾脏病（P<0.001）以及年龄超过80岁（P<0.001）分别是总体再次感染最重要的风险因素。相比之下，初次入院时年龄在19 - 44岁（P<0.001）、插管（P<0.001）、发热（P<0.001）以及咳嗽（P<0.001）分别是总体再次感染最重要的保护因素。
结论
新冠病毒康复后的再次感染和复发以及出院后再次入院的发生率较高。高龄或低龄以及患有癌症和慢性肾脏病等基础疾病会增加感染和再次入院的风险。
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