Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study.
Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study.
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DOI：
10.1016/s2352-3018(21)00151-x
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
DATCOV author group
中科院分区：
文献类型：
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作者：
Jassat W;Cohen C;Tempia S;Masha M;Goldstein S;Kufa T;Murangandi P;Savulescu D;Walaza S;Bam JL;Davies MA;Prozesky HW;Naude J;Mnguni AT;Lawrence CA;Mathema HT;Zamparini J;Black J;Mehta R;Parker A;Chikobvu P;Dawood H;Muvhango N;Strydom R;Adelekan T;Mdlovu B;Moodley N;Namavhandu EL;Rheeder P;Venturas J;Magula N;Blumberg L;DATCOV author group
COVID-19、非传染性疾病以及艾滋病毒和结核病等慢性传染病之间的相互作用尚不清楚，特别是在非洲的低收入和中等收入国家。南非全国15-49岁人群的艾滋病毒流行率为19%，所有年龄段人群的结核病流行率为0.7%。我们利用南非具有全国代表性的医院监测系统，旨在调查与COVID-19患者住院死亡率相关的因素。在这项队列研究中，我们使用了提交给DATCOV的数据，DATCOV是一个针对COVID-19住院的国家主动医院监测系统，针对2020年3月5日至2021年3月27日期间因实验室确诊的SARS-CoV-2感染而入院的患者。年龄、性别、人种或种族以及合并症（高血压、糖尿病、慢性心脏病、慢性肺病和哮喘、慢性肾病、过去5年内的恶性肿瘤、HIV以及既往和当前的结核病）被认为是COVID-19相关住院死亡率的风险因素。COVID-19住院死亡率（主要结局）定义为住院期间发生的与COVID-19相关的死亡，不包括因其他原因或出院后发生的死亡;因此，仅纳入已知住院结局（死亡或活着出院）的患者。使用链式方程多重插补来解释缺失数据，并使用随机效应多变量logistic回归模型来评估HIV状态和基础合并症对COVID-19住院死亡率的作用。在219265名因实验室确诊的SARS-CoV-2感染和已知的住院结局数据而入院的患者中，有51037人（23.3%）死亡。在有可用数据的个体中，最常见的合并症是高血压（61 098/163 350）（37.4%），糖尿病（43 885/159 932）（27.4%），HIV（13 793/151 779）（9.1%）。146381人中有5282人（3.6%）报告了结核病。年龄增长是COVID-19住院死亡率的最强预测因素。其他相关因素包括艾滋病毒感染（校正比值比1.34，95% CI 1.27 - 1.43），既往结核病史（1·26，1·15-1·38），当前结核病（1·42，1·22-1·64），以及过去和现在的结核病（1·48，1·32-1·67）与从未患过结核病的人以及其他描述的COVID-19风险因素（如男性;非白人;在过去5年内有潜在的高血压、糖尿病、慢性心脏病、慢性肾病和恶性肿瘤;以及在公共卫生部门接受过治疗。在调整其他因素后，未接受抗逆转录病毒治疗（ART;调整后的比值比1.45，95%CI 1.22 - 1.72）的HIV感染者比接受ART的HIV感染者更有可能在医院死亡。在HIV感染者中，其他合并症的患病率为29.2%，而在HIV未感染者中为30.8%。在HIV感染者和未感染HIV的个体中，合并症数量的增加与COVID-19住院死亡风险的增加相关。被确定为COVID-19住院死亡风险高的个人（老年人和患有慢性合并症的人以及艾滋病毒感染者，特别是未接受抗逆转录病毒治疗的人）将受益于COVID-19预防计划，如疫苗优先接种以及早期转诊和治疗。南非国民政府。
The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. South African National Government.