目的:我们旨在研究肌肉减少症和肌肉减少性肥胖(SO)对老年COVID-19感染和慢性疾病患者临床结局的影响。
方法:我们前瞻性收集了2022年11月1日至2023年1月31日在华东医院接受COVID-19感染的患者的数据。这些患者来自先前建立的综合老年评估(CGA)队列。我们收集了他们入院前关于肌少症的信息,所以,营养不良,以及他们的医疗。主要终点是插管的发生率,而次要终点包括院内死亡率.然后我们利用Kaplan-Meier(K-M)存活曲线和对数秩检验来比较与插管或死亡相关的临床结果。评估肌肉减少症和SO对患者临床结局的影响。
结果:共有113名患者(年龄89.6±7.0岁)被纳入研究。其中,住院前51例患者患有肌肉减少症,39例患者患有SO。6例无肌少症患者(9.7%)和18例肌少症患者(35.3%)需要插管,其中16例为SO患者(41%)。2例无肌少症患者(3.3%)和13例肌少症患者(25.5%)死亡。其中11例为SO患者(28%)。经进一步分析,在校正混杂因素后,SO患者的插管风险(危险比[HR]7.43,95%置信区间[CI]1.26~43.90,P<0.001)和死亡率(HR6.54,95%CI1.09~39.38,P<0.001)均显著升高.
结论:老年住院患者中肌肉减少症或SO的患病率较高,发现这两种情况对COVID-19感染的临床结局都有显著的负面影响。因此,必须尽早定期评估和干预这些情况。
OBJECTIVE: We aimed to investigate the impact of sarcopenia and sarcopenic obesity (SO) on the clinical outcome in older patients with COVID-19 infection and chronic disease.
METHODS: We prospectively collected data from patients admitted to Huadong Hospital for COVID-19 infection between November 1, 2022, and January 31, 2023. These patients were included from a previously established comprehensive geriatric assessment (CGA) cohort. We collected information on their pre-admission condition regarding sarcopenia, SO, and malnutrition, as well as their medical treatment. The primary endpoint was the incidence of intubation, while secondary endpoints included in-hospital mortality rates. We then utilized Kaplan-Meier (K-M) survival curves and the log-rank tests to compare the clinical outcomes related to intubation or death, assessing the impact of sarcopenia and SO on patient clinical outcomes.
RESULTS: A total of 113 patients (age 89.6 ± 7.0 years) were included in the study. Among them, 51 patients had sarcopenia and 39 had SO prior to hospitalization. Intubation was required for 6 patients without sarcopenia (9.7%) and for 18 sarcopenia patients (35.3%), with 16 of these being SO patients (41%). Mortality occurred in 2 patients without sarcopenia (3.3%) and in 13 sarcopenia patients (25.5%), of which 11 were SO patients (28%). Upon further analysis, patients with SO exhibited significantly elevated risks for both intubation (Hazard Ratio [HR] 7.43, 95% Confidence Interval [CI] 1.26-43.90, P < 0.001) and mortality (HR 6.54, 95% CI 1.09-39.38, P < 0.001) after adjusting for confounding factors.
CONCLUSIONS: The prevalence of sarcopenia or SO was high among senior inpatients, and both conditions were found to have a significant negative impact on the clinical outcomes of COVID-19 infection. Therefore, it is essential to regularly assess and intervene in these conditions at the earliest stage possible.