Characteristics, predictors and outcomes among 99 patients hospitalised with COVID-19 in a tertiary care centre in Switzerland: an observational analysis
Characteristics, predictors and outcomes among 99 patients hospitalised with COVID-19 in a tertiary care centre in Switzerland: an observational analysis
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DOI：
10.4414/smw.2020.20316
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发表时间：
2020-07-15
影响因子：
2.9
通讯作者：
Philipp, Schuetz
中科院分区：
文献类型：
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作者：
Claudia, Gregoriano;Daniel, Koch;Philipp, Schuetz
研究目的：描述2019年冠状病毒病患者的入院特征、风险因素和结局（COVID-19）在大流行早期在瑞士一家三级护理医院住院。方法：这项回顾性队列研究包括患有严重急性呼吸综合征冠状病毒2型的成年患者（SARS-CoV-2）感染，并于2020年2月26日至2020年4月30日期间在Aarau（瑞士）州立医院住院。我们的主要终点是严重的COVID-19进展，定义为转入重症监护室（ICU）和住院死亡率的复合指标。结果：共纳入99例患者（中位年龄67岁[四分位数范围56 - 76]，37%为女性），35%发生严重的COVID-19进展（24%需要ICU治疗，19%死亡）。患者的合并症负担较高，中位Charlson合并症指数为3分，高血压（57%）、慢性肾脏疾病（28%）和肥胖（27%）的患病率较高。根据受试者工作特征曲线下面积，对主要终点具有最高预后价值的基线特征为男性（0.63）和初始实验室检查值，包括休克标志物（乳酸对环境空气0.67;乳酸盐与O-2供应0.70），炎症标志物（C-反应蛋白0.72，降钙素原0.80）和氧合受损标志物（环境空气中pO（2）0.75），而年龄和合并症几乎不能提供预后信息。该分析提供了对疫情初期在瑞士三级医疗医院确诊的首批连续住院患者的深入了解。疾病进展标志物，如炎症标志物、休克标志物和呼吸功能受损标志物，为我们的样本中严重COVID-19进展提供了最多的预后信息。
AIMS OF THE STUDY: To describe admission characteristics, risk factors and outcomes of patients with coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the early phase of the pandemic.METHODS: This retrospective cohort study included adult patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) testing and hospitalised at the cantonal hospital Aarau (Switzerland) between 26 February 2020 and 30 April 2020. Our primary endpoint was severe COVID-19 progression defined as a composite of transfer to the intensive care unit (ICU) and in-hospital mortality.RESULTS: A total of 99 patients (median age 67 years [interquartile range 56-76], 37% females) were included and 35% developed severe COVID-19 progression (24% needed ICU treatment, 19% died). Patients had a high burden of comorbidities with a median Charlson comorbidity index of 3 points and a high prevalence of hypertension (57%), chronic kidney disease (28%) and obesity (27%). Baseline characteristics with the highest prognostic value for the primary endpoint by means of area under the receiver operating characteristic curve were male gender (0.63) and initial laboratory values including shock markers (lactate on ambient air 0.67; lactate with O-2 supply 0.70), markers of inflammation (C-reactive protein 0.72, procalcitonin 0.80) and markers of compromised oxygenation (pO(2) 0.75 on ambient air), whereas age and comorbidities provided little prognostic information.CONCLUSION: This analysis provides insights into the first consecutively hospitalised patients with confirmed COVID-19 at a Swiss tertiary care hospital during the initial period of the pandemic. Markers of disease progression such as inflammatory markers, markers for shock and impaired respiratory function provided the most prognostic information regarding severe COVID-19 progression in our sample.