从早期大流行到三角变异流行期间，原有间质性肺病对 COVID-19 患者死亡率的影响：一项基于全国人口的研究

IF 4.7 2区医学 Q1 RESPIRATORY SYSTEM

Respiratory Research Pub Date : 2024-02-21 DOI:10.1186/s12931-024-02723-3

Koichi Miyashita, Hironao Hozumi, Kazuki Furuhashi, Eiji Nakatani, Yusuke Inoue, Hideki Yasui, Yuzo Suzuki, Masato Karayama, Noriyuki Enomoto, Tomoyuki Fujisawa, Naoki Inui, Toshiyuki Ojima, Takafumi Suda

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引用次数: 0

摘要

据报道，患有原有间质性肺病 (ILD) 的 COVID-19 患者死亡率很高；但这是基于大流行初期的数据。目前还不确定随着新的相关变种的出现以及 COVID-19 疫苗和治疗方法的开发，他们的死亡率会发生怎样的变化。此外，目前还不清楚 ILD 是否仍然是导致死亡的一个风险因素。由于 COVID-19 仍是一个令人担忧的重大问题，因此有必要对患有 ILD 的 COVID-19 患者进行进一步研究。我们从日本全国保险理赔数据库中提取了 2020 年 1 月至 2021 年 8 月期间 COVID-19 患者的数据，并将其分为患有和未患有 ILD 的患者。我们调查了野生型、α型和δ型占优波中已有 ILD 的 COVID-19 患者的全因死亡率，以确定已有 ILD 是否与死亡率增加有关。在 937,758 名 COVID-19 成年患者中，有 7,333 人（0.8%）患有原有的 ILD。在所有 COVID-19 患者中，野生型、α型和δ型显性波中患有原有 ILD 的比例分别为 1.2%、0.8% 和 0.3%，其 60 天死亡率分别为 16.0%、14.6% 和 7.5%。从α波为主到δ波为主，60 天死亡率明显下降（差异-7.1%，95% 置信区间（CI）-9.3% 到-4.9%）。在多变量分析中，原有的 ILD 与所有波的死亡率增加都有独立关联，其中野生型主导波的比值比 (OR) 为 2.10，95% CI 为 1.91-2.30；α 主导波的比值比为 2.14，95% CI 为 1.84-2.50；δ 主导波的比值比为 2.10，95%CI 为 1.66-2.66。从野生型到最近的δ主导波，COVID-19 患者的全因死亡率有所下降。但是，这些患者的死亡风险始终高于无 ILD 的患者。我们强调，尽管 COVID-19 的环境发生了变化，但仍应仔细关注已有 ILD 的患者。

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Impact of preexisting interstitial lung disease on mortality in COVID-19 patients from the early pandemic to the delta variant epidemic: a nationwide population-based study

COVID-19 patients with preexisting interstitial lung disease (ILD) were reported to have a high mortality rate; however, this was based on data from the early stages of the pandemic. It is uncertain how their mortality rates have changed with the emergence of new variants of concern as well as the development of COVID-19 vaccines and treatments. It is also unclear whether having ILD still poses a risk factor for mortality. As COVID-19 continues to be a major concern, further research on COVID-19 patients with preexisting ILD is necessary. We extracted data on COVID-19 patients between January 2020–August 2021 from a Japanese nationwide insurance claims database and divided them into those with and without preexisting ILD. We investigated all-cause mortality of COVID-19 patients with preexisting ILD in wild-type-, alpha-, and delta-predominant waves, to determine whether preexisting ILD was associated with increased mortality. Of the 937,758 adult COVID-19 patients, 7,333 (0.8%) had preexisting ILD. The proportion of all COVID-19 patients who had preexisting ILD in the wild-type-, alpha-, and delta-predominant waves was 1.2%, 0.8%, and 0.3%, respectively, and their 60-day mortality was 16.0%, 14.6%, and 7.5%, respectively. The 60-day mortality significantly decreased from the alpha-predominant to delta-predominant waves (difference − 7.1%, 95% confidence intervals (CI) − 9.3% to − 4.9%). In multivariable analysis, preexisting ILD was independently associated with increased mortality in all waves with the wild-type-predominant, odds ratio (OR) 2.10, 95% CI 1.91–2.30, the alpha-predominant wave, OR 2.14, 95% CI 1.84–2.50, and the delta-predominant wave, OR 2.10, 95%CI 1.66–2.66. All-cause mortality rates for COVID-19 patients with preexisting ILD decreased from the wild-type- to the more recent delta-predominant waves. However, these patients were consistently at higher mortality risk than those without preexisting ILD. We emphasize that careful attention should be given to patients with preexisting ILD despite the change in the COVID-19 environment.

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来源期刊

Respiratory Research 医学-呼吸系统

自引率

1.70%

发文量

314

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.