Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)
Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)
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DOI：
10.1016/j.jhin.2020.07.013
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发表时间：
2020-10-01
影响因子：
6.9
通讯作者：
McCarthy, K.
中科院分区：
文献类型：
--
作者：
Carter, B.;Collins, J. T.;McCarthy, K.
背景：2019年非冠状病毒病（COVID-19）病理的住院人数显著减少。据认为，这可能是由于公众对在医院获得COVID-19感染以及随后的死亡风险感到焦虑所致。目的：确定在医院获得COVID-19的患者（院内COVID-19感染（NC））及其与社区获得COVID-19（CAC）感染患者相比的死亡风险。方法：COPE-院内研究是一项观察性队列研究。主要结局是至全因死亡的时间（采用校正的风险比（aHR）估计），次要结局是第7天死亡率和至出院的时间。采用混合效应多变量考克斯的比例风险模型，调整人口统计学和comorbidity.Findings：该研究包括1564例患者从10个医院网站在整个英国，一个在意大利，并收集到2020年4月28日入院的患者的结果。总体而言，12.5%的COVID-19感染是在医院获得的; 425名（27.2%）COVID患者死亡。NC患者的中位生存期为14天，而CAC患者为10天。在主要分析中，NC感染与较低的死亡率相关（aHR：0.71; 95%置信区间（CI）：0.51-0.98）。次要结局发现，第7天死亡率无差异（校正比值比：0.79; 95%CI：0.47-1.31），但NC患者在恢复期需要更长的住院时间（aHR：0.49，95%CI：0.37-0.66）。结论：少数COVID-19病例是NC传播的结果。没有COVID-19感染是没有风险的，但与CAC感染相比，NC患者的死亡风险较低;然而，在解释这一发现时应谨慎。(C)2020年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality.Aim: To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection.Methods: The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities.Findings: The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51-0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47-1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37-0.66).Conclusion: The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding. (C) 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.