Patient Trajectories Among Persons Hospitalized for COVID-19 A Cohort Study
Patient Trajectories Among Persons Hospitalized for COVID-19 A Cohort Study
复制标题
DOI：
10.7326/m20-3905
复制
发表时间：
2021-01-01
影响因子：
39.2
通讯作者：
Gupta, Amita
中科院分区：
文献类型：
--
作者：
Garibaldi, Brian T.;Fiksel, Jacob;Gupta, Amita
背景：在美国队列中，2019冠状病毒病（COVID-19）进展为严重疾病或死亡的危险因素尚未得到充分探讨。目的：确定预测新型冠状病毒肺炎重症或死亡的住院因素。设计：回顾性队列分析。环境：马里兰州和华盛顿特区的五家医院。患者：2020年3月4日至4月24日期间，832例COVID-19连续入院，随访至2020年6月27日。测量方法：使用世界卫生组织COVID-19疾病严重程度量表对患者轨迹和结果进行分类。主要结局是死亡和严重疾病或死亡的复合结局。结果：患者中位年龄为64岁（范围1 ~ 108岁）；47%是女性，40%是黑人，16%是拉丁裔，21%是养老院的居民。死亡131例（16%），出院694例（83%），其中轻中度523例（63%），重度171例（20%）。死者中，66人（50%）是养老院的居民。在入院的787例轻中度疾病患者中，302例（38%）进展为严重疾病或死亡：181例（60%）到第2天，238例（79%）到第4天。年龄、养老院居住情况、合并症、肥胖、呼吸道症状、呼吸频率、发热、绝对淋巴细胞计数、低白蛋白血症、肌钙蛋白水平和c反应蛋白水平以及这些因素之间的相互作用使患者的疾病进展概率有显著差异。仅使用入院时存在的因素，预测住院疾病进展的模型在第2、4和7天的曲线下面积分别为0.85、0.79和0.79。局限性：该研究是在一个单一的卫生保健系统中完成的。结论：人口统计学和临床变量的组合与COVID-19严重疾病或死亡及其早期发病密切相关。COVID-19住院风险计算器（CIRC）利用入院时存在的因素，可以为临床和资源分配决策提供信息。
Background: Risk factors for progression of coronavirus disease 2019 (COVID-19) to severe disease or death are underexplored in U.S. cohorts.Objective: To determine the factors on hospital admission that are predictive of severe disease or death from COVID-19.Design: Retrospective cohort analysis.Setting: Five hospitals in the Maryland and Washington, DC, area.Patients: 832 consecutive COVID-19 admissions from 4 March to 24 April 2020, with follow-up through 27 June 2020.Measurements: Patient trajectories and outcomes, categorized by using the World Health Organization COVID-19 disease severity scale. Primary outcomes were death and a composite of severe disease or death.Results: Median patient age was 64 years (range, 1 to 108 years); 47% were women, 40% were Black, 16% were Latinx, and 21% were nursing home residents. Among all patients, 131 (16%) died and 694 (83%) were discharged (523 [63%] had mild to moderate disease and 171 [20%] had severe disease). Of deaths, 66 (50%) were nursing home residents. Of 787 patients admitted with mild to moderate disease, 302 (38%) progressed to severe disease or death: 181 (60%) by day 2 and 238 (79%) by day 4. Patients had markedly different probabilities of disease progression on the basis of age, nursing home residence, comorbid conditions, obesity, respiratory symptoms, respiratory rate, fever, absolute lymphocyte count, hypoalbuminemia, troponin level, and C-reactive protein level and the interactions among these factors. Using only factors present on admission, a model to predict in-hospital disease progression had an area under the curve of 0.85, 0.79, and 0.79 at days 2, 4, and 7, respectively.Limitation: The study was done in a single health care system.Conclusion: A combination of demographic and clinical variables is strongly associated with severe COVID-19 disease or death and their early onset. The COVID-19 Inpatient Risk Calculator (CIRC), using factors present on admission, can inform clinical and resource allocation decisions.