Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic
Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic
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DOI：
10.1111/ajt.16840
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发表时间：
2021-10-07
影响因子：
8.8
通讯作者：
Limaye, Ajit P.
中科院分区：
文献类型：
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作者：
Heldman, Madeleine R.;Kates, Olivia S.;Limaye, Ajit P.
因COVID-19住院的患者死亡率在疫情期间有所下降。实体器官移植受者（SOTR）的死亡率趋势尚不清楚。我们使用来自因COVID-19住院的SOTR多中心登记的数据，比较了2020年初（2020年3月1日至2020年6月19日）和2020年末（2020年6月20日至2020年12月31日）的28天死亡率。多变量logistic回归用于评估合并症校正的死亡率。1435/1616（88.8%）SOTR的诊断时间段可用，971/1435（67.7%）住院：2020年初571/753（75.8%）和2020年底402/682（58.9%）（p < .001）。粗28天死亡率在早期和晚期之间降低（112/571 [19.6%] vs. 55/402 [13.7%]），即使在校正基线合并症后，在晚期仍保持较低水平（aOR 0.67，95% CI 0.46-0.98，p = 0.016）。在早期和晚期之间，皮质类固醇的使用（>= 6 mg地塞米松/天）和remdesivir增加（分别为62/571 [10.9%] vs. 243/402 [61.5%]，p < .001和50/571 [8.8%] vs. 213/402 [52.2%]，p < .001），羟氯喹和IL-6/IL-6受体抑制剂的使用减少（分别为329/571 [60.0%] vs. 4/492 [1.0%]，p <0.001和73/571 [12.8%] vs. 5/402 [1.2%]，p <0.001）。SOTR因COVID-19住院的死亡率在2020年初至年底有所下降，与一般人群报告的趋势一致。改善生存率的机制需要进一步研究。
Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020-June 19, 2020) and late 2020 (June 20, 2020-December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46-0.98, p = .016). Between the early and late periods, the use of corticosteroids (>= 6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study.