PDF(Pubmed)
Abstract：
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed a major public health concern worldwide. Patients with comorbid conditions are at risk of adverse outcomes following COVID-19. Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection. It could lead to higher rates of inpatient complications and mortality in this patient population. However, studies on COVID-19 outcomes in liver transplant (LT) recipients have yielded inconsistent findings.
OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.
METHODS: We conducted a retrospective cohort study using the 2019-2020 National Inpatient Sample database. Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classification of Diseases, Tenth Revision coding system. The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic. Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.
RESULTS: A total of 15720 hospitalized LT recipients were included. Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection. In both cohorts, the median admission age was 57 years. The linear trends for LT hospitalizations did not differ significantly before and during the pandemic (P = 0.84). The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020. Compared to the pre-pandemic period, a higher association was noted between LT recipients and in-hospital mortality during the pandemic, with an odds ratio (OR) of 1.69 [95% confidence interval (CI): 1.55-1.84), P < 0.001]. The frequency of transplant rejections among hospitalized LT recipients increased from 0.2% to 3.6% between January 2019 and December 2020. LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic [OR: 1.53 (95%CI: 1.26-1.85), P < 0.001].
CONCLUSIONS: The hospitalization rates for LT recipients were comparable before and during the pandemic. Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.
OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.
METHODS: We conducted a retrospective cohort study using the 2019-2020 National Inpatient Sample database. Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classification of Diseases, Tenth Revision coding system. The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic. Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.
RESULTS: A total of 15720 hospitalized LT recipients were included. Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection. In both cohorts, the median admission age was 57 years. The linear trends for LT hospitalizations did not differ significantly before and during the pandemic (P = 0.84). The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020. Compared to the pre-pandemic period, a higher association was noted between LT recipients and in-hospital mortality during the pandemic, with an odds ratio (OR) of 1.69 [95% confidence interval (CI): 1.55-1.84), P < 0.001]. The frequency of transplant rejections among hospitalized LT recipients increased from 0.2% to 3.6% between January 2019 and December 2020. LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic [OR: 1.53 (95%CI: 1.26-1.85), P < 0.001].
CONCLUSIONS: The hospitalization rates for LT recipients were comparable before and during the pandemic. Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.
摘要：
背景：2019年冠状病毒病（COVID-19）大流行已在全球范围内引起重大公共卫生关注。患有合并症的患者在COVID-19后有不良后果的风险。伴有免疫抑制和合并症的实体器官移植受者更容易受到严重的COVID-19感染。这可能导致该患者人群中住院并发症和死亡率更高。然而,关于肝移植（LT）受者COVID-19结局的研究得出的结果不一致。
目的：评估COVID-19大流行对美国LT接受者医院相关结局的影响。
方法：我们使用2019-2020年全国住院患者样本数据库进行了一项回顾性队列研究。使用国际疾病分类鉴定了原发性LT住院和继发性COVID-19诊断的患者，第十修订编码系统。主要结果包括COVID-19大流行之前和期间LT住院的趋势。次要结果包括LT受者住院死亡率和移植排斥反应的比较趋势。
结果：共纳入15720例住院LT受者。大约0.8%的患者继发诊断为COVID-19感染。在这两个队列中，中位入院年龄为57岁.在大流行之前和期间，LT住院的线性趋势没有显着差异（P=0.84）。在2019年1月至2020年12月期间，LT接受者的住院死亡率从1.7%增加到4.4%。与大流行前相比，在大流行期间，LT接受者与住院死亡率之间的关联更高，比值比(OR)为1.69[95%置信区间(CI)：1.55-1.84)，P<0.001]。在2019年1月至2020年12月期间，住院LT接受者的移植排斥频率从0.2％增加到3.6％。COVID-19大流行期间的LT住院与移植排斥反应的相关性高于大流行前[OR：1.53(95CI：1.26-1.85)，P<0.001]。
结论：在大流行之前和期间，LT受者的住院率相当。在COVID-19大流行期间，住院LT接受者的住院死亡率和移植排斥率增加。
目的：评估COVID-19大流行对美国LT接受者医院相关结局的影响。
方法：我们使用2019-2020年全国住院患者样本数据库进行了一项回顾性队列研究。使用国际疾病分类鉴定了原发性LT住院和继发性COVID-19诊断的患者，第十修订编码系统。主要结果包括COVID-19大流行之前和期间LT住院的趋势。次要结果包括LT受者住院死亡率和移植排斥反应的比较趋势。
结果：共纳入15720例住院LT受者。大约0.8%的患者继发诊断为COVID-19感染。在这两个队列中，中位入院年龄为57岁.在大流行之前和期间，LT住院的线性趋势没有显着差异（P=0.84）。在2019年1月至2020年12月期间，LT接受者的住院死亡率从1.7%增加到4.4%。与大流行前相比，在大流行期间，LT接受者与住院死亡率之间的关联更高，比值比(OR)为1.69[95%置信区间(CI)：1.55-1.84)，P<0.001]。在2019年1月至2020年12月期间，住院LT接受者的移植排斥频率从0.2％增加到3.6％。COVID-19大流行期间的LT住院与移植排斥反应的相关性高于大流行前[OR：1.53(95CI：1.26-1.85)，P<0.001]。
结论：在大流行之前和期间，LT受者的住院率相当。在COVID-19大流行期间，住院LT接受者的住院死亡率和移植排斥率增加。
