Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study
Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study
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DOI：
10.12890/2020_001747
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发表时间：
2020-05-22
影响因子：
105.7
通讯作者：
Horwitz, Leora I.
中科院分区：
文献类型：
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作者：
Petrilli, Christopher M.;Jones, Simon A.;Horwitz, Leora I.
目的描述美国 2019 年冠状病毒病 (covid-19) 入院患者的结局，以及与疾病严重程度相关的临床和实验室特征。设计前瞻性队列研究。设置纽约市和长岛的单一学术医疗中心。参与者 5279 名实验室确诊的严重急性呼吸综合征冠状病毒 2 (SARS-Cov-2) 感染患者 2020年3月1日至2020年4月8日之间。最终随访日期为2020年5月5日。主要观察指标结果为入院、危重疾病（重症监护、机械通气、出院至临终关怀或死亡）以及出院至临终关怀或死亡。预测因素包括患者特征、病史、生命体征和实验室结果。进行多变量逻辑回归以确定不良结果的风险因素，并对死亡率进行竞争风险生存分析。 结果 在 11544 人中接受 SARS-Cov-2 检测，其中 5566 人 (48.2%) 呈阳性。排除后，纳入 5279 人。这5279人中，有2741人（51.9%）入院，其中1904人（69.5%）在没有临终关怀的情况下活着出院，665人（24.3%）出院接受临终关怀或死亡。在 647 例（23.6%）需要机械通气的患者中，391 例（60.4%）死亡，170 例（26.2%）拔管或出院。入院的最大风险与年龄有关，44 岁以上所有年龄组的比值比 >2，75 岁及以上年龄组的比值比为 37.9（95% 置信区间 26.1 至 56.0）。其他风险包括心力衰竭（4.4、2.6至8.0）、男性（2.8、2.4至3.2）、慢性肾病（2.6、1.9至3.6）以及体重指数（BMI）的任何增加（例如，BMI>40：2.5、1.8至3.4）。除年龄外，危重疾病的最大风险与心力衰竭（1.9、1.4至2.5）、BMI>40（1.5、1.0至2.2）和男性（1.5、1.3至1.8）相关。然而，入院时氧饱和度为 1（4.8、2.1 至 10.9）、C 反应蛋白水平 >200（5.1、2.8 至 9.2）和 D-二聚体水平 >2500（3.9、2.6 至 6.0）与危重疾病的相关性高于年龄或合并症。在研究期间，危重疾病的风险显着下降。仅就死亡率而言，也发现了类似的关联。结论发现，年龄和合并症是 covid-19 患者入院的强有力预测因素，在较小程度上是危重疾病和死亡率的预测因素。然而，入院时缺氧和炎症标志物与危重疾病和死亡率的相关性最强。随着时间的推移，结果似乎正在改善，这可能表明护理方面的改善。
OBJECTIVETo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DESIGNProspective cohort study.SETTINGSingle academic medical center in New York City and Long Island.PARTICIPANTS5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.MAIN OUTCOME MEASURESOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.RESULTSOf 11544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9,1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of 1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.CONCLUSIONSAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.