Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study.
Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study.
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DOI：
10.1093/cid/ciaa1091
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发表时间：
2021-12-06
期刊：
影响因子：
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通讯作者：
Nayagam, Shevanthi
中科院分区：
文献类型：
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作者：
Perez-Guzman, Pablo N;Daunt, Anna;Nayagam, Shevanthi
背景：新出现的证据表明，少数族裔受到 2019 年冠状病毒病 (COVID-19) 的影响尤为严重。多文化住院患者队列的详细临床分析在很大程度上仍未描述。方法：我们进行了回归、生存和累积竞争风险分析，以评估与 2 月 25 日至 4 月 5 日期间伦敦 3 家大型医院因 COVID-19 入院的患者死亡率相关的因素，截至 2020 年 5 月 1 日进行审查。结果：在 614 名患者中（中位年龄 69 [四分位距，25] 岁），其中 62% 为男性）， 381 人 (62%) 活着出院，178 人 (29%) 死亡，55 人 (9%) 仍在医院接受审查。严重低氧血症（调整后比值比 [aOR]，4.25 [95% 置信区间 {CI}，2.36-7.64]）、白细胞增多（aOR，2.35 [95% CI，1.35-4.11]）、血小板减少症（aOR [1.01，95% CI，1.00-1.01]，每 109 增加减少）、严重肾功能损害（aOR，5.14 [95% CI，2.65-9.97]）和低白蛋白（aOR，1.06 [95% CI，1.02-1.09]，每克减少增加）与死亡相关。 40% (n = 244) 来自黑人、亚洲人和其他少数族裔 (BAME) 群体，38% (n = 235) 是白人，22% (n = 135) 的种族未知。 BAME 患者更年轻，合并症也更少。尽管未调整的死亡几率没有因种族而异，但在调整年龄、性别和合并症时，黑人患者的死亡几率高于白人（aOR，1.69 [95% CI，1.00-2.86]）。当进一步调整入院严重程度时，这种关联性更强（aOR，1.85 [95% CI，1.06-3.24]）。 结论：在我们的队列中，少数族裔患者的比例过高；当考虑到入院时的人口统计学和临床特征时，黑人患者的死亡几率更高。需要进一步研究不同种族的 COVID-19 结果差异的生物学驱动因素。
BACKGROUND: Emerging evidence suggests ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19). Detailed clinical analyses of multicultural hospitalized patient cohorts remain largely undescribed.METHODS: We performed regression, survival, and cumulative competing risk analyses to evaluate factors associated with mortality in patients admitted for COVID-19 in 3 large London hospitals between 25 February and 5 April, censored as of 1 May 2020.RESULTS: Of 614 patients (median age, 69 [interquartile range, 25] years) and 62% male), 381 (62%) were discharged alive, 178 (29%) died, and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (adjusted odds ratio [aOR], 4.25 [95% confidence interval {CI}, 2.36-7.64]), leukocytosis (aOR, 2.35 [95% CI, 1.35-4.11]), thrombocytopenia (aOR [1.01, 95% CI, 1.00-1.01], increase per 109 decrease), severe renal impairment (aOR, 5.14 [95% CI, 2.65-9.97]), and low albumin (aOR, 1.06 [95% CI, 1.02-1.09], increase per gram decrease) were associated with death. Forty percent (n = 244) were from black, Asian, and other minority ethnic (BAME) groups, 38% (n = 235) were white, and ethnicity was unknown for 22% (n = 135). BAME patients were younger and had fewer comorbidities. Although the unadjusted odds of death did not differ by ethnicity, when adjusting for age, sex, and comorbidities, black patients were at higher odds of death compared to whites (aOR, 1.69 [95% CI, 1.00-2.86]). This association was stronger when further adjusting for admission severity (aOR, 1.85 [95% CI, 1.06-3.24]).CONCLUSIONS: BAME patients were overrepresented in our cohort; when accounting for demographic and clinical profile of admission, black patients were at increased odds of death. Further research is needed into biologic drivers of differences in COVID-19 outcomes by ethnicity.