Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study.
Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study.
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DOI：
10.1136/bmjopen-2020-045482
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发表时间：
2021-02-22
期刊：
影响因子：
2.9
通讯作者：
van den Born BH
中科院分区：
文献类型：
--
作者：
Collard D;Nurmohamed NS;Kaiser Y;Reeskamp LF;Dormans T;Moeniralam H;Simsek S;Douma R;Eerens A;Reidinga AC;Elbers PWG;Beudel M;Vogt L;Stroes ESG;van den Born BH
最近的报告表明，COVID-19 患者高血压和糖尿病的患病率很高，但心血管疾病 (CVD) 危险因素在 COVID-19 临床病程中的作用尚不清楚。我们评估了高血压、血脂异常、糖尿病和 COVID-19 结果之间的时间与事件关系。我们分析了荷兰 CovidPredict 前瞻性队列的数据，这是一项正在进行的针对因 COVID-19 感染入院患者的前瞻性研究。来自八家参与医院的患者，其中包括 CovidPredict 队列中的两家大学医院。已入院的、COVID-19 PCR 呈阳性或胸部 CT 成像高度怀疑的成年患者。对患者住院期间的主要结局进行随访。 CVD危险因素是通过家庭药物清单确定的，分为抗高血压药、降脂药和抗糖尿病药。主要结局是入院后前 21 天内的死亡率，次要结局包括重症监护病房 (ICU) 入住和 ICU 死亡率。 Kaplan-Meier 和 Cox 回归分析用于确定与 CVD 危险因素的关联。我们纳入了 1604 名患者，平均年龄为 66±15 岁，其中 60.5% 为男性。 45%、34.7%和22.1%的患者使用了降压药、降脂药和抗糖尿病药。 21天随访后； 19.2%的患者死亡或出院接受姑息治疗。调整年龄和性别后的 Cox 回归分析显示，≥2 个危险因素的存在与死亡风险增加相关（HR 1.52，95%CI 1.15 至 2.02），但与 ICU 入住无关。此外，使用≥2种抗糖尿病药和≥2种抗高血压药与死亡率相关，与年龄和性别无关，HR分别为2.09（95% CI 1.55至2.80）和1.46（95% CI 1.11至1.91）。高血压、血脂异常和糖尿病的积累会导致住院的 COVID-19 患者的短期死亡风险逐步增加，与年龄和性别无关。有必要进一步研究这些风险因素如何对 COVID-19 患者产生不成比例的影响。
Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes. We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection. Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included. Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics. The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors. We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91). The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.
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影响因子：
11.8
作者：
Violi, Francesco;Cangemi, Roberto;Corrales-Medina, Vicente F.
通讯作者：
Corrales-Medina, Vicente F.
影响因子：
158.5
作者：
Vaduganathan, Muthiah;Vardeny, Orly;Solomon, Scott D.
通讯作者：
Solomon, Scott D.
影响因子：
20.1
作者：
Ungvari Z;Tarantini S;Donato AJ;Galvan V;Csiszar A
通讯作者：
Csiszar A
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,
影响因子：
158.5
作者：
Mancia, Giuseppe;Rea, Federico;Corrao, Giovanni
通讯作者：
Corrao, Giovanni