美国纽约大学格罗斯曼医学院Leora I Horwitz团队对纽约市5279例covid-19患者住院及危重症相关因素进行了分析。2020年5月22日，该研究发表在《英国医学杂志》上。

为了描述美国covid-19住院患者的预后，以及与重症相关的临床和实验室特征，研究组设计了一项前瞻性队列研究。他们在纽约市和长岛市设立了一个学术医疗中心，2020年3月1日至2020年4月8日，招募了5279名经实验室确诊的SARS-Cov-2感染者。主要结局包括入院、重症（重症监护、机械通气）、出院接受临床关怀或死亡。预测因素包括患者特征、病史、生命体征和实验室结果。

5279名患者中，共2741名（51.9％）入院，其中1904名（69.5％）在没有临终关怀的情况下活着出院，665名（24.3％）出院接受临终关怀或死亡。在647名（23.6％）需要机械通气的患者中，391名（60.4％）死亡，170名（26.2％）拔管或出院。住院最大的危险因素是年龄，其中44岁以上人群的比值比超过2，但75岁以上的比值比高达37.9。

其他危险因素还包括心力衰竭（4.4）、男性（2.8）、慢性肾脏疾病（2.6）、体重指数（BMI）升高（BMI>40时为2.5）。除年龄外，与重症相关的危险因素为心力衰竭（1.9）、BMI>40（1.5）和男性（1.5）。与年龄和合并症相比，入院血氧饱和度<88％（3.7）、肌钙蛋白水平>1（4.8）、C反应蛋白水平>200、D-二聚体水平>2500（3.9 ）更容易转为危重症。但在研究期间，重症和死亡的风险逐渐降低。

总之，年龄和并发症是住院的有力预测指标，但对重症和死亡的影响较小。然而，入院时的氧损伤和炎症标志物损害与危重症和死亡密切相关。

附：英文原文

Title: Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

Author: Christopher M Petrilli, Simon A Jones, Jie Yang, Harish Rajagopalan, Luke O’Donnell, Yelena Chernyak, Katie A Tobin, Robert J Cerfolio, Fritz Francois, Leora I Horwitz

Issue&Volume: 2020/05/22

Abstract: Objective To describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.

Design Prospective cohort study.

Setting Single academic medical center in New York City and Long Island.

Participants 5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.

Main outcome measures Outcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.

Results Of 11544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of 1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.

Conclusions Age and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

DOI: 10.1136/bmj.m1966

Source: https://www.bmj.com/content/369/bmj.m1966