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Covid-19和季节性流感相比患者器官功能衰竭和死亡风险显著增加
作者:小柯机器人 发布时间:2020/12/18 21:20:53

美国圣路易斯大学Ziyad Al-Aly团队比较了Covid-19和季节性流感住院患者的临床表现和死亡风险。2020年12月15日,该研究发表在《英国医学杂志》上。

为了比较检查因Covid-19和季节性流感而住院的患者之间临床表现和死亡风险的差异,研究组在美国退伍军人事务所进行了一项队列研究。

研究组招募了2020年2月1日至6月17日间的3641例covid-19住院患者,和2017至2019年间12676例季节性流感住院患者,主要观察指标为临床表现、医疗资源使用以及死亡的风险。

与季节性流感相比,covid-19患者发生急性肾损伤(比值比为1.52)、肾脏替代疗法(4.11)、胰岛素使用(1.86)、严重脓毒性休克(4.04)、使用血管加压药(3.95)、肺栓塞(1.50)、深静脉血栓形成(1.50)、中风(1.62)、急性心肌炎(7.82)、心律失常和心源性猝死(1.76)、肌钙蛋白升高(1.75)、天冬氨酸转氨酶升高(3.16)、谷丙转氨酶升高(2.65)和横纹肌溶解(1.84)的风险显著升高。

与季节性流感相比,covid-19患者发生死亡、使用呼吸机和接受重症监护的风险显著增加,风险比分别为4.97、4.01和2.41,且平均住院天数延长了3天。在covid-19和季节性流感之间,每100名患者死亡率差异最大的是75岁以上患有慢性肾病或痴呆症的老年人,以及患有肥胖,糖尿病或慢性肾病的黑人。

研究结果表明,在住院患者中,与季节性流感相比,covid-19显著增加了肺外器官功能障碍、死亡和增加医疗资源使用的风险。

附:英文原文

Title: Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study

Author: Yan Xie, Benjamin Bowe, Geetha Maddukuri, Ziyad Al-Aly

Issue&Volume: 2020/12/15

Abstract:

Objective To comparatively examine differences in risk of clinical manifestations and death among people admitted to hospital with coronavirus disease 2019 (covid-19) and seasonal influenza.

Design Cohort study.

Setting US Department of Veterans Affairs.

Participants Patients admitted to hospital with covid-19 between 1 February 2020 and 17 June 2020 (n=3641) and seasonal influenza between 2017 and 2019 (n=12676).

Main outcome measures Risks of clinical manifestations, healthcare resource use (including use of mechanical ventilation, admission to intensive care, and length of stay), and death, estimated using a doubly robust approach to build propensity scores that were then used along with covariates to adjust the outcome models.

Results Compared with seasonal influenza, covid-19 was associated with higher risk of acute kidney injury (odds ratio 1.52, 95% confidence interval 1.37 to 1.69), incident renal replacement therapy (4.11, 3.13 to 5.40), incident insulin use (1.86, 1.62 to 2.14), severe septic shock (4.04, 3.38 to 4.83), vasopressor use (3.95, 3.46 to 4.51), pulmonary embolism (1.50, 1.18 to 1.90), deep venous thrombosis (1.50, 1.20 to 1.88), stroke (1.62, 1.17 to 2.24), acute myocarditis (7.82, 3.53 to 17.36), arrythmias and sudden cardiac death (1.76, 1.40 to 2.20), elevated troponin (1.75, 1.50 to 2.05), elevated aspartate aminotransferase (3.16, 2.91 to 3.43), elevated alanine aminotransferase (2.65, 2.43 to 2.88), and rhabdomyolysis (1.84, 1.54 to 2.18). Compared with seasonal influenza, covid-19 was also associated with higher risk of death, mechanical ventilator use, and admission to intensive care (hazard ratio 4.97, (95% confidence interval 4.42 to 5.58), 4.01 (3.53 to 4.54), and 2.41 (2.25 to 2.59), respectively) and 3.00 (2.20 to 3.80) additional days of hospital stay. Differences in rates of death per 100 patients between covid-19 and seasonal influenza were most pronounced in people over 75 years of age with chronic kidney disease or dementia and those with black race and obesity, diabetes, or chronic kidney disease.

Conclusions Among people admitted to hospital, compared with seasonal influenza, covid-19 was associated with increased risk of extrapulmonary organ dysfunction, death, and increased health resource use. The findings may inform the global discussion about the comparative risks of covid-19 and seasonal influenza and may help the ongoing effort to manage the covid-19 global pandemic.

DOI: 10.1136/bmj.m4677

Source: https://www.bmj.com/content/371/bmj.m4677

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj