Clinical Course and Factors Associated With Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois
Clinical Course and Factors Associated With Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois
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DOI：
10.1111/acem.14104
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发表时间：
2020-08-25
影响因子：
4.4
通讯作者：
Hota, Bala
中科院分区：
文献类型：
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作者：
Gottlieb, Michael;Sansom, Sarah;Hota, Bala
背景SARS-CoV-2是一种全球性流行病，发病率和死亡率很高。然而，来自美国队列的信息有限。了解这些患者入院和危重病的预测因素对于指导预防和风险分层策略至关重要。方法这是一项回顾性、基于登记的队列研究，包括2020年3月4日至2020年6月21日期间在伊利诺伊州芝加哥拉什大学医学中心就诊的所有COVID-19患者。从登记处获得人口统计学、临床、实验室和治疗数据，并对住院和非住院患者以及危重患者进行比较。我们使用逻辑回归模型来探索与住院和危重病相关的危险因素。结果该研究共纳入8，673名COVID-19患者，其中1，483名（17.1%）入院，528名（6.1%）入住重症监护室。入院的危险因素包括高龄、男性（比值比[OR] = 1.69，95%置信区间[CI] = 1.44 - 1.98），西班牙裔/拉丁裔（OR = 1.52，95%CI = 1.18 ~ 1.92），高血压（OR = 1.77，95%CI = 1.46 ~ 2.16），糖尿病（OR = 1.84，95% CI = 1.53 - 2.22），既往CVA（OR = 3.20，95%CI = 1.99 ~ 5.14），冠心病（OR = 1.45，95%CI = 1.03 ~ 2.06），心力衰竭（OR = 1.79，95%CI = 1.23 ~ 2.61），慢性肾脏疾病（OR = 2.60，95%CI = 1.77 ~ 3.83），终末期肾病（OR = 2.22，95%CI = 1.12 ~ 4.41），肝硬化发热（OR = 1.43，95% CI = 1.19 ~ 1.71）和呼吸困难（OR = 4.53，95% CI = 3.75 ~ 5.47）。与危重病相关的因素包括男性（OR = 1.45，95%CI = 1.12 ~ 1.88），充血性心力衰竭（OR = 1.45，95%CI = 1.00 ~ 2.12），阻塞性睡眠呼吸暂停（OR = 1.58，95%CI = 1.07 ~ 2.33），血液传播性癌症（OR = 3.53，95%CI = 1.26至9.86），白细胞增多（OR = 1.53，95% CI = 1.15 - 2.17），嗜中性粒细胞/淋巴细胞比值升高（OR = 1.61，95% CI = 1.20 - 2.17），低白蛋白血症（OR = 1.80，95% CI = 1.39 - 2.32），AST升高（OR = 1.66，95% CI = 1.20 - 2.29），乳酸升高（OR = 1.95，95% CI = 1.40 - 2.73）、D-二聚体升高（OR = 1.44，95% CI = 1.05 - 1.97）和肌钙蛋白升高（OR = 3.65，95% CI = 2.03 - 6.57）。结论影响住院和危重病的因素很多。临床医生在评估COVID-19患者时应考虑这些因素。
Background SARS-CoV-2 is a global pandemic associated with significant morbidity and mortality. However, information from United States cohorts is limited. Understanding predictors of admission and critical illness in these patients is essential to guide prevention and risk stratification strategies. Methods This was a retrospective, registry-based cohort study including all patients presenting to Rush University Medical Center in Chicago, Illinois, with COVID-19 from March 4, 2020 to June 21, 2020. Demographic, clinical, laboratory, and treatment data were obtained from the registry and compared between hospitalized and nonhospitalized patients as well as those with critical illness. We used logistic regression modeling to explore risk factors associated with hospitalization and critical illness. Results A total of 8,673 COVID-19 patients were included in the study, of whom 1,483 (17.1%) were admitted to the hospital and 528 (6.1%) were admitted to the intensive care unit. Risk factors for hospital admission included advanced age, male sex (odds ratio [OR] = 1.69, 95% confidence interval [CI] = 1.44 to 1.98), Hispanic/Latino ethnicity (OR = 1.52, 95% CI = 1.18 to 1.92), hypertension (OR = 1.77, 95% CI = 1.46 to 2.16), diabetes mellitus (OR = 1.84, 95% CI = 1.53 to 2.22), prior CVA (OR = 3.20, 95% CI = 1.99 to 5.14), coronary artery disease (OR = 1.45, 95% CI = 1.03 to 2.06), heart failure (OR = 1.79, 95% CI = 1.23 to 2.61), chronic kidney disease (OR = 2.60, 95% CI = 1.77 to 3.83), end-stage renal disease (OR = 2.22, 95% CI = 1.12 to 4.41), cirrhosis (OR = 2.03, 95% CI = 1.42 to 2.91), fever (OR = 1.43, 95% CI = 1.19 to 1.71), and dyspnea (OR = 4.53, 95% CI = 3.75 to 5.47). Factors associated with critical illness included male sex (OR = 1.45, 95% CI = 1.12 to 1.88), congestive heart failure (OR = 1.45, 95% CI = 1.00 to 2.12), obstructive sleep apnea (OR = 1.58, 95% CI = 1.07 to 2.33), blood-borne cancer (OR = 3.53, 95% CI = 1.26 to 9.86), leukocytosis (OR = 1.53, 95% CI = 1.15 to 2.17), elevated neutrophil-to-lymphocyte ratio (OR = 1.61, 95% CI = 1.20 to 2.17), hypoalbuminemia (OR = 1.80, 95% CI = 1.39 to 2.32), elevated AST (OR = 1.66, 95% CI = 1.20 to 2.29), elevated lactate (OR = 1.95, 95% CI = 1.40 to 2.73), elevated D-Dimer (OR = 1.44, 95% CI = 1.05 to 1.97), and elevated troponin (OR = 3.65, 95% CI = 2.03 to 6.57). Conclusion There are a number of factors associated with hospitalization and critical illness. Clinicians should consider these factors when evaluating patients with COVID-19.