Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19.
Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19.
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DOI：
10.1001/jamanetworkopen.2020.29058
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Safo S
中科院分区：
文献类型：
--
作者：
Rosenthal N;Cao Z;Gundrum J;Sianis J;Safo S
在美国医院接受治疗的2019冠状病毒病（COVID-19）患者的流行病学特征是什么？与死亡率相关的危险因素是什么？在2020年4月至5月期间，在美国592家医院接受治疗的64 781例COVID-19患者的队列研究中，住院患者的住院死亡率为20.3%，严重并发症很常见。接受他汀类药物、血管紧张素转换酶抑制剂和钙通道阻滞剂与死亡率降低有关，但羟氯喹和阿奇霉素联合使用与死亡率增加有关。在这项研究中，COVID-19与美国住院患者的严重并发症和死亡有关；某些药物可能与降低死亡率有关。本队列研究分析了在美国医院接受治疗的2019冠状病毒病（COVID-19）患者的特征，并研究了与院内死亡率相关的危险因素。2019年冠状病毒病（COVID-19）已经感染了810多万美国居民，造成超过22.1万人死亡。关于美国COVID-19患者的流行病学和临床结果的研究缺乏。目的：分析在美国医院接受治疗的COVID-19患者的特征，并研究与院内死亡率相关的危险因素。这项队列研究是使用Premier Healthcare Database进行的，该数据库是一个大型的、地理上多样化的全付款人医院管理数据库，包括美国592家急症护理医院。纳入2020年4月1日至5月31日期间主要或次要出院诊断为COVID-19（国际疾病分类，第十版，临床修改诊断代码，U07.1）的住院和医院门诊就诊。根据住院/门诊和生存状况报告患者的特征。与死亡相关的危险因素包括患者特征、急性并发症、合并症和药物。住院死亡率、重症监护病房（ICU）入院、有创机械通气的使用、总住院时间（LOS）、ICU LOS、急性并发症和治疗模式。共分析64 781例新冠肺炎患者（门诊29 479例（45.5%），住院35 302例（54.5%））。门诊患者年龄中位数（四分位间距[IQR]）为46岁（33-59岁），住院患者年龄中位数（52-77岁）；31 968人（49.3%）为男性，25 841人（39.9%）为美国白人，14 340人（22.1%）为美国黑人。住院患者（7164例）的住院死亡率为20.3%。有创机械通气5625例（15.9%），ICU 6849例（19.4%）。中位（IQR）住院LOS为6（3-10）天。ICU的平均生存时间（IQR）为5（2-10）天。住院患者常见的急性并发症包括急性呼吸衰竭（19 706例[55.8%]）、急性肾衰竭（11 971例[33.9%]）和脓毒症（11 910例[33.7%]）。年龄较大是与死亡最密切相关的危险因素（例如，年龄≥80岁vs 18-34岁：比值比[OR]， 16.20; 95% CI, 11.58-22.67; P < .001）。接受他汀类药物治疗(OR, 0.60; 95% CI, 0.56-0.65; P <。001)，血管紧张素转换酶抑制剂(OR, 0.53; 95% CI, 0.46-0.60; P <。0.001)和钙通道阻滞剂（OR, 0.73; 95% CI, 0.68-0.79; P < 0.001）。001)与死亡几率降低有关。与不使用羟氯霉素或阿奇霉素的患者相比，同时使用阿奇霉素和羟氯霉素的患者的死亡几率增加（or, 1.21; 95% CI, 1.11-1.31; P < .001）。在这项针对美国急性护理医院COVID-19感染患者的队列研究中，COVID-19与高ICU住院率和院内死亡率相关。他汀类药物、血管紧张素转换酶抑制剂和钙通道阻滞剂的使用与死亡率降低相关。了解未经证实的治疗方法的潜在益处需要未来的随机试验。
What are the epidemiologic characteristics of patients with coronavirus disease 2019 (COVID-19) treated in US hospitals, and what risk factors are associated with mortality? In this cohort study of 64 781 patients with COVID-19 treated in 592 US hospitals during April and May 2020, the in-hospital mortality rate was 20.3% among inpatients, and severe complications were common. Receipt of statin, angiotensin-converting enzyme inhibitors, and calcium channel blockers were associated with decreased odds of mortality, but the combination use of hydroxychloroquine and azithromycin was associated with increased odds of mortality. In this study, COVID-19 was associated with severe complications and deaths among patients hospitalized in the United States; certain medications may be associated with decreased odds of mortality. This cohort study characterizes patients with coronavirus disease 2019 (COVID-19) who were treated in US hospitals and examines risks factors associated with in-hospital mortality. Coronavirus disease 2019 (COVID-19) has infected more than 8.1 million US residents and killed more than 221 000. There is a dearth of research on epidemiology and clinical outcomes in US patients with COVID-19. To characterize patients with COVID-19 treated in US hospitals and to examine risk factors associated with in-hospital mortality. This cohort study was conducted using Premier Healthcare Database, a large geographically diverse all-payer hospital administrative database including 592 acute care hospitals in the United States. Inpatient and hospital-based outpatient visits with a principal or secondary discharge diagnosis of COVID-19 (International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code, U07.1) between April 1 and May 31, 2020, were included. Characteristics of patients were reported by inpatient/outpatient and survival status. Risk factors associated with death examined included patient characteristics, acute complications, comorbidities, and medications. In-hospital mortality, intensive care unit (ICU) admission, use of invasive mechanical ventilation, total hospital length of stay (LOS), ICU LOS, acute complications, and treatment patterns. Overall, 64 781 patients with COVID-19 (29 479 [45.5%] outpatients; 35 302 [54.5%] inpatients) were analyzed. The median (interquartile range [IQR]) age was 46 (33-59) years for outpatients and 65 (52-77) years for inpatients; 31 968 (49.3%) were men, 25 841 (39.9%) were White US residents, and 14 340 (22.1%) were Black US residents. In-hospital mortality was 20.3% among inpatients (7164 patients). A total of 5625 inpatients (15.9%) received invasive mechanical ventilation, and 6849 (19.4%) were admitted to the ICU. Median (IQR) inpatient LOS was 6 (3-10) days. Median (IQR) ICU LOS was 5 (2-10) days. Common acute complications among inpatients included acute respiratory failure (19 706 [55.8%]), acute kidney failure (11 971 [33.9%]), and sepsis (11 910 [33.7%]). Older age was the risk factor most strongly associated with death (eg, age ≥80 years vs 18-34 years: odds ratio [OR], 16.20; 95% CI, 11.58-22.67; P < .001). Receipt of statins (OR, 0.60; 95% CI, 0.56-0.65; P < .001), angiotensin-converting enzyme inhibitors (OR, 0.53; 95% CI, 0.46-0.60; P < .001), and calcium channel blockers (OR, 0.73; 95% CI, 0.68-0.79; P < .001) was associated with decreased odds of death. Compared with patients with no hydroxychloroquine or azithromycin, patients with both azithromycin and hydroxychloroquine had increased odds of death (OR, 1.21; 95% CI, 1.11-1.31; P < .001). In this cohort study of patients with COVID-19 infection in US acute care hospitals, COVID-19 was associated with high ICU admission and in-hospital mortality rates. Use of statins, angiotensin-converting enzyme inhibitors, and calcium channel blockers were associated with decreased odds of death. Understanding the potential benefits of unproven treatments will require future randomized trials.
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DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
158.5
作者：
Cavalcanti, A. B.;Zampieri, F. G.;Berwanger, O.
通讯作者：
Berwanger, O.
影响因子：
11.1
作者：
Imam, Z.;Odish, F.;Halalau, A.
通讯作者：
Halalau, A.
影响因子：
1.9
作者：
Rubino, Salvatore;Kelvin, Nikki;Kelvin, David J.
通讯作者：
Kelvin, David J.