目的:原发性肾上腺功能不全(PAI)患者被认为特别容易感染COVID-19;然而,人们对它对这个群体的真正影响知之甚少。我们评估了大流行期间PAI患者的发病率和健康促进态度。
方法:横截面,单中心研究。
方法:2020年5月,向在大型二级/三级护理中心注册的所有PAI患者分发了关于社交距离和病假规则的COVID-19建议。2021年初使用半结构化问卷对患者进行调查。
结果:在207名接触患者中,162回答(82/111患有艾迪生病,AD;80/96伴先天性肾上腺增生,CAH).AD患者年龄大于CAH患者(中位年龄51岁vs.39岁;p<0.001),并有更多的合并症(Charlson合并症指数≥247.6%vs.10.0%;p<0.001)。到调查的时候,47名患者(29.0%)被诊断为COVID-19,这是研究期间病假给药的第二常见原因,也是肾上腺危象的主要触发因素(4/18例)。与AD相比,CAH患者患COVID-19的风险更高(调整后比值比2.53[95%CI1.07-6.16],p=0.036),不太愿意接种COVID-19疫苗(80.0%vs.96.3%;p=0.001),并且不太可能接受过氢化可的松自我注射训练(80.0%vs.91.5%;p=0.044)或佩戴医疗警示首饰(36.3%vs.64.6%;p=0.001)。
结论:COVID-19是PAI患者肾上腺危象和病日给药的主要诱因。尽管患COVID-19的风险较高,但CAH患者对自我保护态度的参与度较低。
UNASSIGNED: Patients with primary adrenal insufficiency (PAI) are thought to be particularly vulnerable to coronavirus disease 2019 (COVID-19); however, little is known about its true impact on this group. We assessed morbidity and health promotion attitudes during the pandemic amongst a large cohort of patients with PAI.
UNASSIGNED: Cross-sectional, single-centre
study.
UNASSIGNED: In May 2020, COVID-19 advice on social distancing and sick-day rules was distributed to all patients with PAI registered with a large secondary/tertiary care centre. A semi-structured questionnaire was used to survey patients in early 2021.
UNASSIGNED: Of 207 contacted patients, 162 responded (82/111 with Addison\'s disease, AD; 80/96 with congenital adrenal hyperplasia, CAH). Patients with AD were older than those with CAH (median age 51 vs 39 years; P < 0.001) and had more comorbidities (Charlson comorbidity index ≥2 47.6% vs 10.0%; P< 0.001). By the time of the survey, 47 patients (29.0%) had been diagnosed with COVID-19, the second commonest cause of sick-day dosing during the
study and the leading trigger of adrenal crises (4/18 cases). Patients with CAH had a higher risk of COVID-19 compared to AD (adjusted odds ratio 2.53 (95% CI 1.07-6.16), P= 0.036), were less inclined to have the COVID-19 vaccine (80.0% vs 96.3%; P = 0.001), and were less likely to have undergone hydrocortisone self-injection training (80.0% vs 91.5%; P = 0.044) or wear medical alert jewellery (36.3% vs 64.6%; P = 0.001).
UNASSIGNED: COVID-19 was a principal trigger for adrenal crises and sick-day dosing in patients with PAI. Despite a higher risk of COVID-19, patients with CAH showed less engagement with self-protective attitudes.
UNASSIGNED: We conducted a cross-sectional
study on a large and well-characterised group of patients with PAI and demonstrated that COVID-19 was a leading cause of morbidity during the early phases of the pandemic. Patients with AD were older and had a greater burden of comorbidity than those with CAH, including non-adrenal autoimmune disorders. However, patients with CAH were more likely to develop COVID-19 and demonstrated reduced engagement with healthcare services and health promotion strategies.