Influence of cardiovascular disease and cardiovascular risk factors in COVID-19 patients. Data from a large prospective Spanish cohort
Influence of cardiovascular disease and cardiovascular risk factors in COVID-19 patients. Data from a large prospective Spanish cohort
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心血管疾病和心血管危险因素对COVID-19患者的影响。来自大型前瞻性西班牙队列的数据
DOI：
10.1016/j.rccl.2020.11.004
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发表时间：
2020-11-17
期刊：
影响因子：
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通讯作者：
Vaquerizo B
中科院分区：
文献类型：
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作者：
García-Guimaraes M;Mojón D;Calvo A;Izquierdo A;Belarte-Tornero L;Salvatella N;Llagostera M;Negrete A;Mas-Stachurska A;Ruiz S;Valdivielso S;Ribas N;Marrugat J;Farré N;Vaquerizo B
2019 年冠状病毒病 (COVID-19) 已成为一种流行病。回顾性数据显示，患有心血管疾病（CVD）和心血管（CV）危险因素的患者预后较差。我们的目的是评估 CVD 和 CV 危险因素与 COVID-19 患者的院内结局之间的联系。我们设计了一个前瞻性登记册，其中包括我们机构连续收治的 COVID-19 患者。纳入期为2020年2月27日至4月7日。临床结果监测截至2020年5月2日。总共纳入876名患者。平均年龄为 62 ± 18 岁； 47% 的年龄> 65 岁。总共 69% 的患者至少有一种心血管危险因素； 15%的患者既往有CVD病史。既往有 CVD 的患者年龄明显较大（77 ± 11 岁 vs 60 ± 18 岁；P < .01），其中男性比例较高（64 vs 54%；P = .021），并且高敏心脏特异性肌钙蛋白-T (hs-cTnT)（78 vs 27%；P < .01）和 N 端升高比例较高入院时 B 型利钠肽原 (NT-proBNP)（74% vs 29%；P < .01）。具有心血管危险因素的患者年龄也明显较大（68 ± 16 岁 vs 49 ± 16 岁；P < .01），表明满足急性窘迫呼吸综合征标准的患者比例较高（28 vs 21%；P = .021），并且需要更多机械通气（9 vs 4%；P < .01）。在有心血管危险因素的患者中，hs-cTnT（44 vs 9%；P < .01）和 NT-proBNP（43 vs 15%；P < .01）水平更常见升高。患有 CVD（33% vs 8%；P <.01）或 CV 危险因素（16 vs 1%；P <.01）的患者的死亡风险显着较高。我们发现年龄> 65岁（OR，15；95%CI，5-43）、慢性充血性心力衰竭（OR，3.27；95%CI，1.38-7.72）和慢性肾病（OR，8.55；95%CI，1.47-5.46）是死亡的独立预测因素。在因 COVID-19 入院的患者中，CVD 或 CV 危险因素与住院期间死亡风险增加相关。我们发现，年龄较大、充血性心力衰竭病史和慢性肾脏病是 COVID-19 死亡的独立预测因素。
Coronavirus disease 2019 (COVID-19) has become a pandemic. Retrospective data showed worse outcomes in patients with cardiovascular disease (CVD) and cardiovascular (CV) risk factors. Our aim was to evaluate the link between CVD and CV risk factors and in-hospital outcomes in COVID-19 patients. We designed a prospective registry that included consecutive COVID-19 patients admitted at our institution. The inclusion period was from 27 February to 7 April 2020. Clinical outcomes were monitored up to 2 May 2020. A total of 876 patients were included. Mean age was 62 ± 18 years old; 47% were > 65 years of age. A total of 69% of patients had at least one CV risk factor; 15% of the patients had previous history of CVD. Patients with previous CVD were significantly older (77 ± 11 vs 60 ± 18 years old; P < .01), with a higher proportion of men (64 vs 54%; P = .021) and showed a higher proportion of rise in both high-sensitivity cardiac-specific troponin-T (hs-cTnT) (78 vs 27%; P < .01) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (74 vs 29%; P < .01) on admission. Those patients with CV risk factors were also significantly older (68 ± 16 vs 49 ± 16 years old; P < .01), showing a higher percentage of patients fulfilling acute distress respiratory syndrome criteria (28 vs 21%; P = .021) and more need of mechanical ventilation (9 vs 4%; P < .01). Levels of hs-cTnT (44 vs 9%; P < .01) and NT-proBNP (43 vs 15%; P < .01) were more frequently elevated in patients with CV risk factors. Risk of death was significantly higher in patients with CVD (33 vs 8%; P < .01) or CV risk factors (16 vs 1%; P < .01). We found age > 65 years old (OR, 15; 95%CI, 5–43), chronic congestive heart failure (OR, 3.27; 95%CI, 1.38–7.72) and chronic kidney disease (OR, 8.55; 95%CI, 1.47–5.46) as independent predictors of death. In patients admitted for COVID-19, CVD or CV risk factors are associated with an increased risk of death during hospitalization. We found that older age, history of congestive heart failure and chronic kidney disease are independent predictors of death in COVID-19.