PDF(Pubmed)
Abstract：
OBJECTIVE: Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19.
METHODS: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness.
RESULTS: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality.
CONCLUSIONS: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.
METHODS: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness.
RESULTS: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality.
CONCLUSIONS: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.
摘要：
■2019年医院获得性冠状病毒病（COVID-19）进展为危重疾病的危险因素仍然未知。这里,我们评估了医院获得性COVID-19患者进展为危重症的发生率和危险因素,并确定了它们对临床结局的影响.
■这项回顾性队列研究分析了2020年1月至2022年6月期间三甲医院收治的确诊为医院获得性COVID-19的患者。主要结果是医院获得性COVID-19进展为危重病。患者被分层为高，中介-，或低风险组进展为危重病的危险因素的数量。
■总共，包括204例患者，37例（18.1%）进展为危重症。在多变量逻辑分析中，患有呼吸系统疾病的患者(OR，3.90；95%CI，1.04-15.18），预先存在的心血管疾病(OR，3.49；95%CI，1.11-11.27），免疫受损状态（OR，3.18；95%CI，1.11-9.16），较高的序贯器官衰竭评估(SOFA)评分(OR，1.56；95%CI，1.28-1.96），和较高的临床虚弱量表(OR，2.49；95%CI，1.62-4.13）显示进展为危重病的风险显著增加。随着人群风险的增加，患者进展为危重病的可能性显著增加,且28日死亡率较高.
■在医院获得性COVID-19，先前存在呼吸系统疾病的患者中，预先存在的心血管疾病，免疫受损状态，基线时更高的临床虚弱量表和SOFA评分是进展为危重疾病的危险因素。有这些危险因素的患者必须优先考虑,适当隔离或及时治疗,尤其是在大流行环境中。
■这项回顾性队列研究分析了2020年1月至2022年6月期间三甲医院收治的确诊为医院获得性COVID-19的患者。主要结果是医院获得性COVID-19进展为危重病。患者被分层为高，中介-，或低风险组进展为危重病的危险因素的数量。
■总共，包括204例患者，37例（18.1%）进展为危重症。在多变量逻辑分析中，患有呼吸系统疾病的患者(OR，3.90；95%CI，1.04-15.18），预先存在的心血管疾病(OR，3.49；95%CI，1.11-11.27），免疫受损状态（OR，3.18；95%CI，1.11-9.16），较高的序贯器官衰竭评估(SOFA)评分(OR，1.56；95%CI，1.28-1.96），和较高的临床虚弱量表(OR，2.49；95%CI，1.62-4.13）显示进展为危重病的风险显著增加。随着人群风险的增加，患者进展为危重病的可能性显著增加,且28日死亡率较高.
■在医院获得性COVID-19，先前存在呼吸系统疾病的患者中，预先存在的心血管疾病，免疫受损状态，基线时更高的临床虚弱量表和SOFA评分是进展为危重疾病的危险因素。有这些危险因素的患者必须优先考虑,适当隔离或及时治疗,尤其是在大流行环境中。
