Clinical frailty, and not features of acute infection, is associated with late mortality in COVID-19: a retrospective cohort study.
Clinical frailty, and not features of acute infection, is associated with late mortality in COVID-19: a retrospective cohort study.
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DOI：
10.1002/jcsm.12966
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发表时间：
2022-06
期刊：
影响因子：
--
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中科院分区：
文献类型：
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2019冠状病毒病（COVID-19）与出院后的死亡率过高有关。需要识别出院后死亡风险增加的患者，以指导临床监测和早期干预。在此，我们旨在确定COVID-19患者早期与晚期死亡率的预测因素。共有471例经聚合酶链反应确诊的COVID-19患者在入院后接受了9个月的随访[中位（四分位数间距）随访时间：271（14）天]。通过logistic回归分析COVID-19相关体征和症状、实验室特征、合并症、冠状病毒临床表征联盟（4C）死亡率和临床虚弱量表（CFS）评分与早期（28天）vs晚期死亡率的相关性。采用受试者工作特征（ROC）分析确定4C和CFS评分对早期与晚期死亡率的判别值。共有120名患者在入院后28天内死亡。在剩下的351名患者中，有41人在接下来的8个月内死亡。调整年龄和性别后，呼吸衰竭、全身炎症和肾损害与早期死亡率相关，而活动性癌症和痴呆与晚期死亡率相关。4C死亡率评分和CFS与早期[比值比（OR）（95%置信区间-CI）：4C：1.34（1.25-1.45）; CFS：1.49（1.33-1.66）]和晚期[OR（95% CI）：4C：1.23（1.12-1.36）; CFS：2.04（1.62-2.56）]死亡率相关。校正CFS后，4C和晚期死亡率之间的关联消失。通过ROC分析，4C死亡率评分在28天死亡率方面上级CFS [曲线下面积（AUC）（95% CI）：分别为0.779（0.732-0.825）vs. 0.723（0.673-0.773）; P = 0.039]。相比之下，与4C死亡率评分相比，CFS对晚期死亡率具有更高的预测值[AUC（95% CI）：分别为0.830（0.776-0.883）vs. 0.724（0.650-0.798）; P = 0.007]。在我们的队列中，COVID-19患者的晚期死亡率与病前临床虚弱的相关性比与急性感染期的严重性更强。
Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C: 1.34 (1.25–1.45); CFS: 1.49 (1.33–1.66)] and late [OR (95% CI): 4C: 1.23 (1.12–1.36); CFS: 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.
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DOI：
10.3390/medsci9010006
发表时间：
2021-02-04
期刊：
Medical sciences (Basel, Switzerland)
影响因子：
--
作者：
Baker KF;Hanrath AT;van der Loeff IS;Tee SA;Capstick R;Marchitelli G;Li A;Barr A;Eid A;Ahmed S;Bajwa D;Mohammed O;Alderson N;Lendrem C;Lendrem DW;Covid-Control Group;Covid-Clinical Group;Pareja-Cebrian L;Welch A;Field J;Payne BAI;Taha Y;Price DA;Gibbins C;Schmid ML;Hunter E;Duncan CJA
通讯作者：
Duncan CJA
影响因子：
20.3
作者：
Giannis D;Allen SL;Tsang J;Flint S;Pinhasov T;Williams S;Tan G;Thakur R;Leung C;Snyder M;Bhatia C;Garrett D;Cotte C;Isaacs S;Gugerty E;Davidson A;Marder GS;Schnitzer A;Goldberg B;McGinn T;Davidson KW;Barish MA;Qiu M;Zhang M;Goldin M;Matsagkas M;Arnaoutoglou E;Spyropoulos AC
通讯作者：
Spyropoulos AC
DOI：
10.1136/bmj.i2375
发表时间：
2016-05-17
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Prescott HC;Osterholzer JJ;Langa KM;Angus DC;Iwashyna TJ
通讯作者：
Iwashyna TJ
影响因子：
9.6
作者：
Ferrante, Lauren E.;Pisani, Margaret A.;Gill, Thomas M.
通讯作者：
Gill, Thomas M.
影响因子：
3
作者：
BOZDOGAN, H
通讯作者：
BOZDOGAN, H