Laboratory Findings Associated With Severe Illness and Mortality Among Hospitalized Individuals With Coronavirus Disease 2019 in Eastern Massachusetts.
Laboratory Findings Associated With Severe Illness and Mortality Among Hospitalized Individuals With Coronavirus Disease 2019 in Eastern Massachusetts.
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DOI：
10.1001/jamanetworkopen.2020.23934
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Perlis RH
中科院分区：
文献类型：
--
作者：
Castro VM;McCoy TH;Perlis RH
截至2020年6月5日，马萨诸塞州东部因2019年冠状病毒病（COVID-19）住院的个体的社会人口统计学特征、实验室检查值和合并症在多大程度上可以预测严重的病程？在这项队列研究中，对2511名经聚合酶链反应检测为严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）阳性的住院患者进行了队列研究，这些患者被送往6家医院中的1家医院，其中215人（8.6%）被送往重症监护室，164人（6.5%）需要机械通气，292人（11.6%）死亡。在风险预测模型中，212例死亡（78%）发生在死亡风险最高的五分之一人群中。简单的预测模型可能有助于对COVID-19住院患者进行风险分层。2019冠状病毒病（COVID-19）大流行给全球卫生系统带来了前所未有的压力，需要对医院不良后果的风险进行可靠的估计。量化马萨诸塞州东部6家医院与危重病和死亡风险相关的入院实验室和合并症特征。对截至2020年6月5日通过聚合酶链反应检测出严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）阳性的所有住院患者进行回顾性队列研究，使用来自2家学术医疗中心和4家社区医院的急诊科和住院患者的医院病程、既往诊断和实验室值。数据提取于2020年6月11日，分析于2020年6月至7月进行。SARS-CoV-2.严重疾病定义为进入重症监护室、机械通气或死亡。在2511名SARS-CoV-2检测呈阳性的住院患者中（其中50.9%为男性，53.9%为白色，27.0%为西班牙裔，平均[SD ]年龄为62.6 [19.0]岁），215人（8.6%）进入重症监护室，164人（6.5%）需要机械通气，292人（11.6%）死亡。在这些医院中的3所开发的L1回归模型产生了严重疾病的受试者工作特征曲线下的面积为0.807，在3所医院中死亡率为0.847。总的来说，292例死亡中有212例（72.6%）发生在死亡率最高的五分之一人群中。在该队列中，特定的入院实验室研究与社会人口统计学特征和既往诊断相结合，促进了因COVID-19住院的个体的风险分层。这项队列研究评估了马萨诸塞州东部6家医院因2019冠状病毒病（COVID-19）住院的患者中与危重疾病和死亡风险相关的入院实验室和合并症特征。
How well can sociodemographic features, laboratory values, and comorbidities of individuals hospitalized with coronavirus disease 2019 (COVID-19) in Eastern Massachusetts through June 5, 2020, predict a severe illness course? In this cohort study of 2511 hospitalized individuals positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction who were admitted to 1 of 6 hospitals, 215 (8.6%) were admitted to the instensive care unit, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died. In a risk prediction model, 212 deaths (78%) occurred in the top mortality-risk quintile. Simple prediction models may assist in risk stratification among hospitalized patients with COVID-19. The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented stress on health systems across the world, and reliable estimates of risk for adverse hospital outcomes are needed. To quantify admission laboratory and comorbidity features associated with critical illness and mortality risk across 6 Eastern Massachusetts hospitals. Retrospective cohort study of all individuals admitted to the hospital who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction across these 6 hospitals through June 5, 2020, using hospital course, prior diagnoses, and laboratory values in emergency department and inpatient settings from 2 academic medical centers and 4 community hospitals. The data were extracted on June 11, 2020, and the analysis was conducted from June to July 2020. SARS-CoV-2. Severe illness defined by admission to intensive care unit, mechanical ventilation, or death. Of 2511 hospitalized individuals who tested positive for SARS-CoV-2 (of whom 50.9% were male, 53.9% White, and 27.0% Hispanic, with a mean [SD ]age of 62.6 [19.0] years), 215 (8.6%) were admitted to the intensive care unit, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died. L1-regression models developed in 3 of these hospitals yielded an area under the receiver operating characteristic curve of 0.807 for severe illness and 0.847 for mortality in the 3 held-out hospitals. In total, 212 of 292 deaths (72.6%) occurred in the highest-risk mortality quintile. In this cohort, specific admission laboratory studies in concert with sociodemographic features and prior diagnosis facilitated risk stratification among individuals hospitalized for COVID-19. This cohort study assesses admission laboratory and comorbidity features associated with critical illness and mortality risk among patients hospitalized with coronavirus disease 2019 (COVID-19) across 6 Eastern Massachusetts hospitals.
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