医院人群容易受到COVID-19的影响,但与社区相比,医院获取的相对严重程度尚不清楚。我们调查了威尔士医院和社区获得性病例死亡率的差异。我们将2020年2月至2022年3月的SARS-CoV-2PCR测试与入院联系起来,以确定可能的医院获取。我们测量了阳性标本(死亡率)后28天的任何原因的死亡,通过收购。我们使用多变量逻辑回归来比较死亡率,调整混杂因素,用95%置信区间(95CI)计算调整比值比(AOR)。在研究期间,有25,263例COVID-19医院病例和5490例(22%)死亡。尽管在单变量分析中很重要,与COVID-19入院的病例相比,混杂因素校正后显示,与住院病例死亡率增加无相关性(aOR=0.8,95CI=0.7-0.8).接种疫苗(aOR=0.6,95CI=0.5-0.7)和在随后的大流行浪潮中的感染(aOR=0.5,95CI=0.4-0.6)与较低的死亡率相关;年龄较大(85岁vs<25岁:aOR=76.4,95CI=41.8-160.5)和男性(aOR=1.5,95CI=1.4-1.6)与较高的死亡率相关。五分之一的住院COVID-19病例在感染后一个月内死亡。院内病例的死亡率并不比COVID-19入院的死亡率低,这可能反映了通过筛查对院内病例的早期识别。
BACKGROUND: Hospital populations are vulnerable to COVID-19, but the relative severity of hospital acquisition compared to community is unknown. We investigated differences in mortality between hospital and community acquired cases in Wales.
METHODS: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction tests from February 2020 to March 2022 were linked with hospital admissions to identify likely hospital-acquired cases. All-cause mortality within 28 days of a positive SARS-CoV-2 were measured by source of acquisition. Multi-variable logistic regression was used to compare mortality by source of acquisition, adjusting for confounders, computing adjusted odds ratios (aOR) with 95% confidence intervals (CI).
RESULTS: There were 25,263 hospital-acquired cases of COVID-19 and 5490 (22%) deaths in the study period. Although significant on univariate analysis, adjustment for confounding showed no association with increased mortality for hospital-acquired cases compared with cases admitted with COVID-19 (aOR 0.8, 95% CI 0.7-0.8). Vaccination (aOR 0.6, 95% CI 0.5-0.7) and infection in later pandemic waves (aOR 0.5, 95% CI 0.4-0.6) were associated with lower mortality; older age (≥85 vs <25 years: aOR 76.4, 95% CI 41.8-160.5) and male sex (aOR 1.5, 95% CI 1.4-1.6) were associated with higher mortality.
CONCLUSIONS: One in five hospitalised COVID-19 cases died within a month of infection. Mortality in nosocomial cases was not worse than those admitted with COVID-19, possibly reflecting early identification of nosocomial cases through screening.