PDF(Pubmed)
Abstract：
Identifying risk factors for progression to severe COVID-19 requiring urgent medical visits and hospitalizations (UMVs) among patients initially diagnosed in the outpatient setting may help inform patient management. The objective of this study was to estimate the incidence of and risk factors for COVID-19-related UMVs after outpatient COVID-19 diagnosis or positive SARS-CoV-2 test.
Data for this retrospective cohort study were from the Optum® de-identified COVID-19 Electronic Health Record database from June 1 to December 9, 2020. Adults with first COVID-19 diagnosis or positive SARS-CoV-2 test in outpatient settings were identified. Cumulative incidence function analysis stratified by risk factors was used to estimate the 30-day incidence of COVID-19-related UMVs. Competing risk regression models were used to derive adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for factors associated with UMVs.
Among 206,741 patients [58.8% female, 77.5% non-Hispanic Caucasian, mean (SD) age: 46.7 (17.8) years], the 30-day incidence was 9.4% (95% CI 9.3-9.6) for COVID-19-related emergency room (ER)/urgent care (UC)/hospitalizations and 3.8% (95% CI 3.7-3.9) for COVID-19-related hospitalizations. Likelihood of hospitalization increased with age and body mass index, with age the strongest risk factor (aHR 5.61; 95% CI 4.90-6.32 for patients ≥ 85 years). Increased likelihood of hospitalization was observed for first presentation in the ER/UC vs. non-ER/UC outpatient settings (aHR 2.35; 95% CI 2.22-2.47) and prior all-cause hospitalization (aHR 1.90; 95% CI 1.79-2.00). Clinical risk factors of hospitalizations included pregnancy, uncontrolled diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and autoimmune disease. A study limitation is that data on COVID-19 severity and symptoms were not captured.
Predictors of COVID-19-related UMVs include older age, obesity, and several comorbidities. These findings may inform patient management and resource allocation following outpatient COVID-19 diagnosis.
Data for this retrospective cohort study were from the Optum® de-identified COVID-19 Electronic Health Record database from June 1 to December 9, 2020. Adults with first COVID-19 diagnosis or positive SARS-CoV-2 test in outpatient settings were identified. Cumulative incidence function analysis stratified by risk factors was used to estimate the 30-day incidence of COVID-19-related UMVs. Competing risk regression models were used to derive adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for factors associated with UMVs.
Among 206,741 patients [58.8% female, 77.5% non-Hispanic Caucasian, mean (SD) age: 46.7 (17.8) years], the 30-day incidence was 9.4% (95% CI 9.3-9.6) for COVID-19-related emergency room (ER)/urgent care (UC)/hospitalizations and 3.8% (95% CI 3.7-3.9) for COVID-19-related hospitalizations. Likelihood of hospitalization increased with age and body mass index, with age the strongest risk factor (aHR 5.61; 95% CI 4.90-6.32 for patients ≥ 85 years). Increased likelihood of hospitalization was observed for first presentation in the ER/UC vs. non-ER/UC outpatient settings (aHR 2.35; 95% CI 2.22-2.47) and prior all-cause hospitalization (aHR 1.90; 95% CI 1.79-2.00). Clinical risk factors of hospitalizations included pregnancy, uncontrolled diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and autoimmune disease. A study limitation is that data on COVID-19 severity and symptoms were not captured.
Predictors of COVID-19-related UMVs include older age, obesity, and several comorbidities. These findings may inform patient management and resource allocation following outpatient COVID-19 diagnosis.
摘要：
在最初在门诊诊断的患者中，确定需要紧急就诊和住院（UMV）的严重COVID-19的危险因素可能有助于告知患者管理。这项研究的目的是评估门诊COVID-19诊断或SARS-CoV-2检测阳性后COVID-19相关UMV的发生率和危险因素。
这项回顾性队列研究的数据来自2020年6月1日至12月9日Optum®去识别的COVID-19电子健康记录数据库。确定了在门诊首次诊断为COVID-19或SARS-CoV-2检测阳性的成年人。使用按危险因素分层的累积发生率功能分析来估计COVID-19相关UMV的30天发生率。使用竞争风险回归模型得出与UMV相关因素的调整风险比（aHR）和95％置信区间（95％CI）。
在206,741名患者中[58.8％为女性，77.5%非西班牙裔高加索人，平均（SD）年龄：46.7（17.8）岁]，COVID-19相关急诊室(ER)/紧急护理(UC)/住院的30天发病率为9.4%(95%CI9.3-9.6),COVID-19相关住院的30天发病率为3.8%(95%CI3.7-3.9).住院的可能性随着年龄和体重指数的增加而增加，年龄是最强的危险因素（aHR5.61；≥85岁患者的95％CI4.90-6.32）。在ER/UC中首次出现时观察到住院的可能性增加。非ER/UC门诊设置(aHR2.35;95%CI2.22-2.47)和先前的全因住院(aHR1.90;95%CI1.79-2.00)。住院的临床危险因素包括妊娠，不受控制的糖尿病，慢性阻塞性肺疾病,慢性肾病,和自身免疫性疾病。一项研究的局限性是，没有获得关于COVID-19严重程度和症状的数据。
与COVID-19相关的UMV的预测因素包括年龄较大，肥胖，和几种合并症。这些发现可能会为门诊COVID-19诊断后的患者管理和资源分配提供信息。
这项回顾性队列研究的数据来自2020年6月1日至12月9日Optum®去识别的COVID-19电子健康记录数据库。确定了在门诊首次诊断为COVID-19或SARS-CoV-2检测阳性的成年人。使用按危险因素分层的累积发生率功能分析来估计COVID-19相关UMV的30天发生率。使用竞争风险回归模型得出与UMV相关因素的调整风险比（aHR）和95％置信区间（95％CI）。
在206,741名患者中[58.8％为女性，77.5%非西班牙裔高加索人，平均（SD）年龄：46.7（17.8）岁]，COVID-19相关急诊室(ER)/紧急护理(UC)/住院的30天发病率为9.4%(95%CI9.3-9.6),COVID-19相关住院的30天发病率为3.8%(95%CI3.7-3.9).住院的可能性随着年龄和体重指数的增加而增加，年龄是最强的危险因素（aHR5.61；≥85岁患者的95％CI4.90-6.32）。在ER/UC中首次出现时观察到住院的可能性增加。非ER/UC门诊设置(aHR2.35;95%CI2.22-2.47)和先前的全因住院(aHR1.90;95%CI1.79-2.00)。住院的临床危险因素包括妊娠，不受控制的糖尿病，慢性阻塞性肺疾病,慢性肾病,和自身免疫性疾病。一项研究的局限性是，没有获得关于COVID-19严重程度和症状的数据。
与COVID-19相关的UMV的预测因素包括年龄较大，肥胖，和几种合并症。这些发现可能会为门诊COVID-19诊断后的患者管理和资源分配提供信息。
