Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study.
Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study.
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DOI：
10.1016/j.numecd.2020.07.031
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发表时间：
2020-10-30
期刊：
影响因子：
--
通讯作者：
COvid-19 RISk and Treatments (CORIST) collaboration
中科院分区：
文献类型：
--
作者：
Di Castelnuovo A;Bonaccio M;Costanzo S;Gialluisi A;Antinori A;Berselli N;Blandi L;Bruno R;Cauda R;Guaraldi G;My I;Menicanti L;Parruti G;Patti G;Perlini S;Santilli F;Signorelli C;Stefanini GG;Vergori A;Abdeddaim A;Ageno W;Agodi A;Agostoni P;Aiello L;Al Moghazi S;Aucella F;Barbieri G;Bartoloni A;Bologna C;Bonfanti P;Brancati S;Cacciatore F;Caiano L;Cannata F;Carrozzi L;Cascio A;Cingolani A;Cipollone F;Colomba C;Crisetti A;Crosta F;Danzi GB;D'Ardes D;de Gaetano Donati K;Di Gennaro F;Di Palma G;Di Tano G;Fantoni M;Filippini T;Fioretto P;Fusco FM;Gentile I;Grisafi L;Guarnieri G;Landi F;Larizza G;Leone A;Maccagni G;Maccarella S;Mapelli M;Maragna R;Marcucci R;Maresca G;Marotta C;Marra L;Mastroianni F;Mengozzi A;Menichetti F;Milic J;Murri R;Montineri A;Mussinelli R;Mussini C;Musso M;Odone A;Olivieri M;Pasi E;Petri F;Pinchera B;Pivato CA;Pizzi R;Poletti V;Raffaelli F;Ravaglia C;Righetti G;Rognoni A;Rossato M;Rossi M;Sabena A;Salinaro F;Sangiovanni V;Sanrocco C;Scarafino A;Scorzolini L;Sgariglia R;Simeone PG;Spinoni E;Torti C;Trecarichi EM;Vezzani F;Veronesi G;Vettor R;Vianello A;Vinceti M;De Caterina R;Iacoviello L;COvid-19 RISk and Treatments (CORIST) collaboration
在欧洲国家，人们对与不良后果和住院死亡率风险相关的特征、合并症和实验室措施了解甚少。我们的目的是确定导致COVID-19患者院内死亡的基线特征。对意大利30个临床中心于2020年2月19日至5月23日住院的3894例SARS-CoV-2感染患者进行回顾性观察研究。基于机器学习（随机森林）和Cox生存分析。61.7%的参与者为男性（中位年龄67岁），随访时间中位数为13天。住院死亡率呈现出地理梯度，意大利北部地区的死亡率是中部/南部地区的两倍多（分别为15.6%和6.4%）。机器学习分析显示，死亡分类中最重要的特征是肾功能受损、C反应蛋白升高和高龄。多变量Cox生存分析证实了这些发现(风险比（HR）： 8.2；年龄≥85岁的95%置信区间（CI） 4.6-14.7 vs 18-44岁；hr = 4.7；估计肾小球滤过率水平<15 vs≥90 mL/min/1.73 m2为2.9-7.7；hr = 2.3；c反应蛋白水平≥10 vs≤3mg /L 1.5-3.6)。与肥胖、吸烟、心血管疾病及相关合并症无相关性。这些变量与死亡率之间的关联在所有亚组分析中基本一致。肾功能受损、c反应蛋白升高和高龄是意大利30个不同临床中心收治的大量未入选COVID-19患者住院死亡的主要预测因素。肾功能受损、c反应蛋白升高和高龄是COVID-19患者死亡的主要指标。这些关联在分析的所有亚组中基本上是同质的。与肥胖、吸烟、心血管疾病及相关合并症无相关性。意大利北部地区的死亡率高于中南部地区。
There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6–14.7 for age ≥85 vs 18–44 y); HR = 4.7; 2.9–7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5–3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy. Impaired renal function, elevated C-reactive protein and advanced age were major indicators of death in COVID-19 patients. These associations were substantially homogenous across all sub-groups analysed. No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. Death rates were higher in the Northern as opposed to Central-Southern Italian regions.
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DOI：
10.1016/j.numecd.2020.04.013
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影响因子：
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