背景:在美国,酒精相关性肝硬化(AC)导致显著的肝脏相关死亡率。已知引起免疫功能障碍和凝血异常。患有AC等合并症的患者面临2019年冠状病毒病(COVID-19)临床预后更差的风险。AC和COVID-19死亡率之间的具体关联仍然没有定论,鉴于先前研究缺乏有力的临床证据。
目的:研究美国COVID-19住院患者AC的死亡率和转归的预测因素。
方法:我们使用2020年全国住院患者样本(NIS)数据库进行了一项回顾性队列研究。根据AC的潜在诊断,确定了患者的主要COVID-19住院治疗。根据基线社会人口统计学特征和Elixhauser合并症,在1:N倾向评分匹配后,确定了一个无AC的COVID-19患者的匹配比较队列。主要结果包括中位住院时间,住院费用中位数,和住院死亡率。次要结果包括全身并发症的发生率。
结果:共有1325例COVID-19合并AC的患者与1135例无AC的患者相匹配。COVID-19合并AC与非AC患者的中位住院时间和住院费用无差异(P>0.05)。感染性休克的患病率增加(5.7%vs4.1%),心室颤动/心室颤动(0.4%vs0%),心房颤动(13.2%vs8.8%),房扑(8.7%vs4.4%),一级房室结传导阻滞(0.8%vs0%),上肢静脉血栓栓塞(1.5%vs0%),与非AC队列相比,AC队列中的静脉曲张出血(3.8%vs0%)(P<0.05)。与AC相比,COVID-19非AC患者的住院死亡率没有差异,比值比为0.97(95%置信区间:0.78-1.22,P=0.85)。死亡率的预测因素包括高龄,心律失常,凝血病,蛋白质-热量营养不良,液体和电解质紊乱,感染性休克,上肢静脉血栓栓塞.
结论:AC不会增加COVID-19住院患者的死亡率。与非AC相比,患有AC的COVID-19患者的住院并发症之间的关联增加。
BACKGROUND: Alcohol-associated cirrhosis (AC) contributes to significant liver-related mortality in the United States. It is known to cause immune dysfunction and coagulation abnormalities. Patients with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019 (COVID-19). The specific association between AC and COVID-19 mortality remains inconclusive, given the lack of robust clinical evidence from prior studies.
OBJECTIVE: To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United States.
METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database 2020. Patients were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC. A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser comorbidities. Primary outcomes included median length of stay, median inpatient charges, and in-hospital mortality. Secondary outcomes included a prevalence of systemic complications.
RESULTS: A total of 1325 COVID-19 patients with AC were matched to 1135 patients without AC. There was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC (P > 0.05). There was an increased prevalence of septic shock (5.7% vs 4.1%), ventricular fibrillation/ventricular flutter (0.4% vs 0%), atrial fibrillation (13.2% vs 8.8%), atrial flutter (8.7% vs 4.4%), first-degree atrioventricular nodal block (0.8% vs 0%), upper extremity venous thromboembolism (1.5% vs 0%), and variceal bleeding (3.8% vs 0%) in the AC cohort compared to the non-AC cohort (P < 0.05). There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC, with an odds ratio of 0.97 (95% confidence interval: 0.78-1.22, P = 0.85). Predictors of mortality included advanced age, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, fluid and electrolyte disorders, septic shock, and upper extremity venous thromboembolism.
CONCLUSIONS: AC does not increase mortality in patients hospitalized with COVID-19. There is an increased association between inpatient complications among COVID-19 patients with AC compared to non-AC.