Association of Psychiatric Disorders With Mortality Among Patients With COVID-19
Association of Psychiatric Disorders With Mortality Among Patients With COVID-19
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DOI：
10.1001/jamapsychiatry.2020.4442
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发表时间：
2021-01-27
期刊：
影响因子：
25.8
通讯作者：
Goff, Donald C.
中科院分区：
文献类型：
--
作者：
Nemani, Katlyn;Li, Chenxiang;Goff, Donald C.
重要性 迄今为止，尚未评估 2019 年冠状病毒病 (COVID-19) 感染者的精神科诊断与死亡率之间的关系。 目的 评估精神分裂症谱系障碍、情绪障碍或焦虑症的诊断是否与 COVID-19 患者的死亡率相关。 设计、环境和参与者 这项回顾性队列研究对 7348 名连续成年患者进行了 45 天的评估2020 年 3 月 3 日至 5 月 31 日期间，在纽约的一个大型学术医疗系统中出现了实验室确诊的 COVID-19。最终随访日期为 2020 年 7 月 15 日。测试前没有可用医疗记录的患者被排除在外。 暴露 根据测试日期之前的以下国际疾病统计分类、第十次修订版、临床修改诊断对患者进行分类：(1) 精神分裂症谱系障碍、(2) 情绪障碍和 (3) 焦虑症。将做出这些诊断的患者与没有精神疾病的参考组进行比较。 主要结果和指标 死亡率，定义为严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 检测结果呈阳性后 45 天内死亡或出院到临终关怀医院。 结果 在 26 540 名接受检测的患者中，7348 名 SARS-CoV-2 检测呈阳性（平均 [SD] 年龄，54 [18.6] 岁； 3891 [53.0%] 女性）。在符合条件的检测结果呈阳性的患者中，75 名患者（1.0%）有精神分裂症谱系疾病史，564 名患者（7.7%）有情绪障碍史，360 名患者（4.9%）有焦虑症史。调整人口和医疗风险因素后，精神分裂症谱系障碍的病前诊断与死亡率显着相关（比值比 [OR]，2.67；95% CI，1.48-4.80）。调整后，情绪障碍（OR，1.14；95% CI，0.87-1.49）和焦虑症（OR，0.96；95% CI，0.65-1.41）的诊断与死亡率无关。与其他危险因素相比，精神分裂症的诊断与死亡率的关联强度仅次于年龄。结论和相关性在纽约大型医疗系统中对 SARS-CoV-2 检测结果呈阳性的成年人进行的这项队列研究中，诊断为精神分裂症谱系障碍的成年人与死亡风险增加相关，但患有情绪和焦虑障碍的成年人与死亡风险无关。这些结果表明，精神分裂症谱系障碍可能是 COVID-19 患者死亡的危险因素。
IMPORTANCE To date, the association of psychiatric diagnoses with mortality in patients infected with coronavirus disease 2019 (COVID-19) has not been evaluated.OBJECTIVE To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed 7348 consecutive adult patients for 45 days following laboratory-confirmed COVID-19 between March 3 and May 31, 2020, in a large academic medical system in New York. The final date of follow-up was July 15, 2020. Patients without available medical records before testing were excluded.EXPOSURES Patients were categorized based on the following International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnoses before their testing date: (1) schizophrenia spectrum disorders, (2) mood disorders, and (3) anxiety disorders. Patients with these diagnoses were compared with a reference group without psychiatric disorders.MAIN OUTCOMES AND MEASURES Mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result.RESULTS Of the 26 540 patients tested, 7348 tested positive for SARS-CoV-2 (mean [SD] age, 54 [18.6] years; 3891 [53.0%] women). Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio [OR], 2.67; 95% CI, 1.48-4.80). Diagnoses of mood disorders (OR, 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR, 0.96; 95% CI, 0.65-1.41) were not associated with mortality after adjustment. In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality.CONCLUSIONS AND RELEVANCE In this cohort study of adults with SARS-CoV-2-positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality. These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in patients with COVID-19.