大流行前肺功能和结构与COVID-19结局的关联：C4R研究

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE

American journal of respiratory and critical care medicine Pub Date : 2025-04-16 DOI:10.1164/rccm.202408-1656oc

Pallavi P Balte,John S Kim,Yifei Sun,Nori Allen,Elsa Angelini,Alexander Arynchyn,R Graham Barr,Michael Blaha,Russell Bowler,Jeff Carr,Shelley A Cole,David Couper,Ryan T Demmer,Margaret Doyle,Mitchell Elkind,Raúl San José Estépar,Olga Garcia-Bedoya,Suresh Garudadri,Nadia N Hansel,Emilia A Hermann,Eric A Hoffman,Stephen M Humphries,Gary M Hunninghake,Robert Kaplan,Jerry A Krishnan,Andrew Laine,Joyce S Lee,David A Lynch,Barry Make,Kunihiro Matsushita,Will McKleroy,Yuan-I Min,Sneha N Naik,George O'Connor,Olivia O'Driscoll,Eyal Oren,Anna J Podolanczuk,Wendy S Post,Tess Pottinger,Elizabeth Regan,Annie Rusk,Mary Salvatore,David A Schwartz,Benjamin Smith,Daniela Sotres-Alvarez,Jason G Umans,Ramachandran S Vasan,George Washko,Sally Wenzel,Prescott Woodruff,Vanessa Xanthakis,Victor E Ortega,Elizabeth C Oelsner

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引用次数: 0

摘要

据报道，在临床肺病患者中，COVID-19住院和死亡的风险增加。目的测试美国成人大流行前肺功能和结构的客观测量与COVID-19结局的相关性。方法基于11个前瞻性美国普通人群队列的最新肺活量测定，定义大流行前梗阻（FEV1/FVC<0.70）和受限（FEV1/FVC≥0.7，FVC<80%）。严重梗阻以FEV1<50%为分级标准。在一个亚群的计算机断层扫描（CT）上定义了肺气肿、高衰减区（HAA）和间质性肺异常（ILA）的百分比。通过问卷调查、血清调查和2020-2023年的医疗记录确定事件COVID-19，并将其分为严重（住院或死亡）和非严重。针对社会人口统计学、人体测量学、吸烟、合并症和COVID-19疫苗接种状况调整了病因特异性危险模型。在29,323名参与者（平均年龄67岁）中，自2020年3月1日起的中位随访时间为17.3个月，共有748例严重事件COVID-19病例。严重COVID-19的更大危险与严重梗阻（与正常相比，aHR=2.11;95%CI:1.02-1.27）、受限（与正常相比，aHR=1.40;95%CI:1.12-1.76）和肺气肿百分比（最高四分位数对最低四分位数，aHR= 1.64;95%CI:1.03-2.61）相关，但与更大的HAA或ILAs无关。COVID-19疫苗接种在这些群体中提供了更大的绝对风险降低。在没有吸烟、肥胖或临床心肺疾病的参与者中，结果相似。结论大流行前严重肺活量测量阻塞、肺活量测量受限以及CT显示肺气肿比例较高与严重COVID-19的风险相关。这些发现支持加强对肺部健康受损个体的COVID-19风险缓解，并为进一步研究肺功能、结构和对急性呼吸道疾病的易感性之间的相互作用提供了依据。本文在知识共享署名非商业禁止衍生品许可4.0 （http://creativecommons.org/licenses/by-nc-nd/4.0/）的条款下开放获取和分发。

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Associations of Pre-Pandemic Lung Function and Structure with COVID-19 Outcomes: The C4R Study.

RATIONALE Increased risk of COVID-19 hospitalization and death has been reported among patients with clinical lung disease. OBJECTIVE To test the association of objective measures of pre-pandemic lung function and structure with COVID-19 outcomes in US adults. METHODS Pre-pandemic obstruction (FEV1/FVC<0.70) and restriction (FEV1/FVC≥0.7, FVC<80%) were defined based on the most recent spirometry exam conducted in 11 prospective US general population-based cohorts. Severe obstruction was classified by FEV1<50%. Percent emphysema, percent high attenuation areas (HAA), and interstitial lung abnormalities (ILA) were defined on computed tomography (CT) in a subset. Incident COVID-19 was ascertained via questionnaires, serosurvey, and medical records from 2020-2023, and classified as severe (hospitalized or fatal) or non-severe. Cause-specific hazards models were adjusted for socio-demographics, anthropometry, smoking, comorbidities, and COVID-19 vaccination status. MEASUREMENTS AND MAIN RESULTS Among 29,323 participants (mean age, 67 years), there were 748 severe incident COVID-19 cases over median follow-up of 17.3 months from March 1, 2020. Greater hazards of severe COVID-19 were associated with severe obstruction (vs normal, aHR=2.11;95%CI:1.02-1.27), restriction (vs normal, aHR=1.40;95%CI:1.12-1.76), and percent emphysema (highest vs lowest quartile, aHR= 1.64;95%CI:1.03-2.61), but not greater HAA or ILAs. COVID-19 vaccination provided greater absolute risk reduction in these groups. Results were similar in participants without smoking, obesity, or clinical cardiopulmonary disease. CONCLUSIONS Pre-pandemic severe spirometric obstruction, spirometric restriction, and greater percent emphysema lung on CT were associated with risk of severe COVID-19. These findings support enhanced COVID-19 risk mitigation for individuals with impaired lung health and warrant further mechanistic studies on interactions of lung function, structure, and vulnerability to acute respiratory illnesses. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.