Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection.
Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection.
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DOI：
10.1001/jamanetworkopen.2020.22310
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发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Fan VS
中科院分区：
文献类型：
--
作者：
Ioannou GN;Locke E;Green P;Berry K;O'Hare AM;Shah JA;Crothers K;Eastment MC;Dominitz JA;Fan VS
严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染患者中与住院、机械通气和死亡相关的危险因素是什么？在这项对88747名接受SARS-CoV-2检测的退伍军人进行的全国队列研究中，SARS-CoV-2检测结果阳性的患者的住院率、机械通气率和死亡率显著高于检测结果阴性的患者。死亡率的重要风险因素包括年龄较大，2019年区域冠状病毒病负担高，Charlson Comorbid指数评分较高，发热，呼吸困难和许多常规实验室检查结果异常;然而，肥胖，黑人，西班牙裔，慢性阻塞性肺疾病，高血压和吸烟与死亡率无关。在这项研究中，大多数死于SARS-CoV-2的患者年龄在50岁或以上，男性，合并症负担更大。这项队列研究确定了严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）患者与住院、机械通气和死亡率相关的过度风险和风险因素。识别严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染患者不良结局的独立风险因素可以支持预防、资源利用和治疗。确定与SARS-CoV-2感染患者住院、机械通气和死亡率相关的过度风险和风险因素。这项纵向队列研究包括2020年2月28日至5月14日期间通过聚合酶链反应检测SARS-CoV-2核酸的88747名患者，并随访至2020年6月22日，在退伍军人事务部（VA）国家医疗保健系统中，包括10131名检测阳性的患者（11.4%）。社会人口学特征、共病情况、症状和实验室检查结果。使用考克斯比例风险模型，在时间-事件分析中估计住院、机械通气和死亡的风险。10131例SARS-CoV-2退伍军人主要为男性（9221例[91.0%]），具有不同的种族/民族（5022例[49.6%]白色，4215例[41.6%]黑人和944例[9.3%]西班牙裔），平均（SD）年龄为63.6（16.2）岁。与SARS-CoV-2检测阴性的患者相比，检测阳性的患者30天住院率更高（30.4% vs 29.3%;校正风险比[aHR]，1.13; 95% CI，1.08-1.13），机械通气（6.7% vs 1.7%; aHR，4.15; 95% CI，3.74-4.61）和死亡（10.8% vs 2.4%; aHR，4.44; 95% CI，4.07-4.83）。在SARS-CoV-2检测呈阳性的患者中，与死亡率显著相关的特征包括年龄较大（例如，≥80岁vs <50岁：aHR，60.80; 95% CI，29.67-124.61），高区域COVID-19疾病负担（例如，≥700 vs <130例死亡/100万居民：aHR，1.21; 95% CI，1.02-1.45），较高的Charlson合并症指数评分（例如，≥5 vs 0：aHR，1.93; 95% CI，1.54-2.42），发热（aHR，1.51; 95% CI，1.32-1.72），呼吸困难（aHR，1.78; 95%CI，1.53-2.07），以及某些血液检查异常，这些异常表现出与死亡率的剂量反应相关性，包括天冬氨酸转氨酶（>89 U/L vs ≤25 U/L：aHR，1.86; 95% CI，1.35-2.57），肌酐（>3.80 mg/dL vs 0.98 mg/dL：aHR，3.79; 95% CI，2.62-5.48）和中性粒细胞与淋巴细胞比率（>12.70 vs ≤2.71：aHR，2.88; 95% CI，2.12-3.91）。除地理区域外，相同的协变量与机械通气独立相关，沿着黑人（aHR，1.52; 95% CI，1.25-1.85），男性（aHR，2.07; 95% CI，1.30-3.32）、糖尿病（aHR，1.40; 95% CI，1.18-1.67）和高血压（aHR，1.30; 95% CI，1.03-1.64）。在校正分析中与死亡率无显著相关的显著特征包括肥胖（体重指数≥35 vs 18.5-24.9：aHR，0.97; 95% CI，0.77-1.21），黑人（aHR，1.04; 95% CI，0.88-1.21），西班牙裔（aHR，1.03; 95% CI，0.79-1.35），慢性阻塞性肺疾病（aHR，1.02; 95% CI，0.88-1.19）、高血压（aHR，0.95; 95% CI，0.81-1.12）和吸烟（例如，当前vs从未：aHR，0.87; 95% CI，0.67-1.13）。该队列中的大多数死亡发生在年龄≥ 50岁（63.4%）、男性（12.3%）和Charlson合并症指数评分至少为1（11.1%）的患者中。在这个VA患者的国家队列中，大多数SARS-CoV-2死亡与年龄较大、男性和合并症负担相关。许多先前在小型研究中报道的与死亡率相关的因素没有得到证实，如肥胖、黑人、西班牙裔、慢性阻塞性肺疾病、高血压和吸烟。
What are the risk factors associated with hospitalization, mechanical ventilation, and death among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? In this national cohort study of 88 747 veterans tested for SARS-CoV-2, hospitalization, mechanical ventilation, and mortality were significantly higher in patients with positive SARS-CoV-2 test results than among those with negative test results. Significant risk factors for mortality included older age, high regional coronavirus disease 2019 burden, higher Charlson Comorbidity Index score, fever, dyspnea, and abnormal results in many routine laboratory tests; however, obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking were not associated with mortality. In this study, most deaths from SARS-CoV-2 occurred in patients with age of 50 years or older, male sex, and greater comorbidity burden. This cohort study identifies excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can support prognostication, resource utilization, and treatment. To identify excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. This longitudinal cohort study included 88 747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between Feburary 28 and May 14, 2020, and followed up through June 22, 2020, in the Department of Veterans Affairs (VA) national health care system, including 10 131 patients (11.4%) who tested positive. Sociodemographic characteristics, comorbid conditions, symptoms, and laboratory test results. Risk of hospitalization, mechanical ventilation, and death were estimated in time-to-event analyses using Cox proportional hazards models. The 10 131 veterans with SARS-CoV-2 were predominantly male (9221 [91.0%]), with diverse race/ethnicity (5022 [49.6%] White, 4215 [41.6%] Black, and 944 [9.3%] Hispanic) and a mean (SD) age of 63.6 (16.2) years. Compared with patients who tested negative for SARS-CoV-2, those who tested positive had higher rates of 30-day hospitalization (30.4% vs 29.3%; adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.13), mechanical ventilation (6.7% vs 1.7%; aHR, 4.15; 95% CI, 3.74-4.61), and death (10.8% vs 2.4%; aHR, 4.44; 95% CI, 4.07-4.83). Among patients who tested positive for SARS-CoV-2, characteristics significantly associated with mortality included older age (eg, ≥80 years vs <50 years: aHR, 60.80; 95% CI, 29.67-124.61), high regional COVID-19 disease burden (eg, ≥700 vs <130 deaths per 1 million residents: aHR, 1.21; 95% CI, 1.02-1.45), higher Charlson comorbidity index score (eg, ≥5 vs 0: aHR, 1.93; 95% CI, 1.54-2.42), fever (aHR, 1.51; 95% CI, 1.32-1.72), dyspnea (aHR, 1.78; 95% CI, 1.53-2.07), and abnormalities in the certain blood tests, which exhibited dose-response associations with mortality, including aspartate aminotransferase (>89 U/L vs ≤25 U/L: aHR, 1.86; 95% CI, 1.35-2.57), creatinine (>3.80 mg/dL vs 0.98 mg/dL: aHR, 3.79; 95% CI, 2.62-5.48), and neutrophil to lymphocyte ratio (>12.70 vs ≤2.71: aHR, 2.88; 95% CI, 2.12-3.91). With the exception of geographic region, the same covariates were independently associated with mechanical ventilation along with Black race (aHR, 1.52; 95% CI, 1.25-1.85), male sex (aHR, 2.07; 95% CI, 1.30-3.32), diabetes (aHR, 1.40; 95% CI, 1.18-1.67), and hypertension (aHR, 1.30; 95% CI, 1.03-1.64). Notable characteristics that were not significantly associated with mortality in adjusted analyses included obesity (body mass index ≥35 vs 18.5-24.9: aHR, 0.97; 95% CI, 0.77-1.21), Black race (aHR, 1.04; 95% CI, 0.88-1.21), Hispanic ethnicity (aHR, 1.03; 95% CI, 0.79-1.35), chronic obstructive pulmonary disease (aHR, 1.02; 95% CI, 0.88-1.19), hypertension (aHR, 0.95; 95% CI, 0.81-1.12), and smoking (eg, current vs never: aHR, 0.87; 95% CI, 0.67-1.13). Most deaths in this cohort occurred in patients with age of 50 years or older (63.4%), male sex (12.3%), and Charlson Comorbidity Index score of at least 1 (11.1%). In this national cohort of VA patients, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden. Many factors previously reported to be associated with mortality in smaller studies were not confirmed, such as obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin
影响因子：
11.1
作者：
Imam, Z.;Odish, F.;Halalau, A.
通讯作者：
Halalau, A.
影响因子：
8.2
作者：
Cariou, Bertrand;Hadjadj, Samy;Gourdy, Pierre
通讯作者：
Gourdy, Pierre
DOI：
10.15585/mmwr.mm6912e2
发表时间：
2020-03-27
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
CDC COVID-19 Response Team
通讯作者：
CDC COVID-19 Response Team