目标:地方性SARS-CoV-2感染仍然给医疗保健系统带来负担,并对脆弱的患者群体构成相当大的威胁。特别是免疫功能低下(IC)患者。本研究旨在分析德国严重SARS-CoV-2感染的IC患者的院内预后。
方法:本回顾性研究,观察性研究,分析了2022年1月1日至2022年12月31日期间来自84家德国Helios医院的住院病例(n=146,324)的管理数据,涉及在Omicron占优势的前12个月内IC患者的住院结局和医疗负担.作为首要目标,通过比较有IC诊断(n=2037)和无IC诊断(n=14,772)的患者,分析了COVID-19相关严重急性呼吸道感染(SARI)患者的院内结局.对患有(n=2037)和无COVID-19相关SARI(n=129,515)的IC患者进行了二次分析。如果满足以下标准之一,则根据WHO定义将严重的住院结局定义为复合终点:重症监护病房(ICU)治疗,机械通气(MV),或在医院死亡。
结果:总计,12%的COVID相关SARI病例为IC患者,占ICU入院人数的15%,MV使用量的15%,16%的死亡,与非IC患者相比,IC患者发生COVID-19相关SARI的严重住院病程患病率更高(赔率,OR=1.4,p<0.001),基于较高的住院死亡率(OR=1.4,p<0.001),ICU治疗(OR=1.3,p<0.001)和机械通气(OR=1.2,p<0.001)的需求增加。在IC患者中,与COVID-19相关的SARI大大增加了严重病程的风险(OR=4.0,p<0.001)。
结论:我们的发现强调了IC患者对重症COVID-19的脆弱性。在Omicron时代,这些患者严重结局的持续高患病率强调了对IC患者进行持续住院风险评估和监测的必要性。
OBJECTIVE: Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany.
METHODS: This retrospective, observational study, analyzed administrative data from inpatient cases (n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (
SARI) were analyzed by comparing patients with (n = 2037) and without IC diagnoses (n = 14,772). Secondary analyses were conducted on IC patients with (n = 2037) and without COVID-19-related
SARI (n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death.
RESULTS: In total, 12% of COVID-related
SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related
SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related
SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001).
CONCLUSIONS: Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients.