{"title":"低氧血症COVID-19肺炎患者继发肺部感染对死亡率的预测因素及影响:一项回顾性队列研究","authors":"","doi":"10.35755/jmedassocthai.2023.07.13765","DOIUrl":null,"url":null,"abstract":"Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19.\n\nObjective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients.\n\nMaterials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI.\n\nResults: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p<0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p<0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients.\n\nConclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients.\n\nKeywords: COVID-19; Secondary pulmonary infection; Mortality; Risk factors","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive Factors and Impact of Secondary Pulmonary Infection on Mortality in Patients with Hypoxemic COVID-19 Pneumonia: A Retrospective Cohort Study\",\"authors\":\"\",\"doi\":\"10.35755/jmedassocthai.2023.07.13765\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19.\\n\\nObjective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients.\\n\\nMaterials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI.\\n\\nResults: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p<0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p<0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients.\\n\\nConclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients.\\n\\nKeywords: COVID-19; Secondary pulmonary infection; Mortality; Risk factors\",\"PeriodicalId\":17486,\"journal\":{\"name\":\"Journal of the Medical Association of Thailand = Chotmaihet thangphaet\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-07-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Medical Association of Thailand = Chotmaihet thangphaet\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.35755/jmedassocthai.2023.07.13765\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.35755/jmedassocthai.2023.07.13765","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景:继发性肺部感染(SPI)是COVID-19患者的严重并发症。目的:探讨低氧血症COVID-19肺炎患者SPI相关危险因素、死亡率及并发症。材料与方法:在萨拉布里医院进行回顾性队列研究,分析512例住院COVID-19患者的医疗记录。Fine-Gray模型确定了SPI的危险因素。结果:新冠肺炎低氧血症患者SPI阳性率为25.4%。SPI患者(平均年龄65.9±15.1岁)比非SPI患者有更高的炎症生物标志物、更高的住院死亡率(IHM)和更多的并发症。引起IHM的主要病原菌为革兰氏阴性菌,占59.23%。SPI的危险因素包括65岁及以上(sHR 1.52;95% CI 1.03 ~ 2.25;p=0.032),肥胖(sHR 1.52;95% CI 1.04 ~ 2.23;p=0.028),有创机械通气(sHR 2.87;95% CI 1.64 ~ 5.02;p<0.001),乳酸脱氢酶(LDH)水平520 U/L及以上(sHR 2.37;95% CI 1.69 ~ 3.33;p=0.027),导管相关血流感染(sHR 2.74;95% CI 1.71 - 4.40;p < 0.001)。SPI患者的IHM率为74.62%。多变量分析显示SPI患者IHM较高(aOR 5.29;95% CI 2.70 - 10.36)与非spi患者相比。结论:SPI是COVID-19低氧性肺炎常见且有害的并发症。老年、肥胖、有创机械通气、LDH水平升高和导管相关血流感染是SPI的重要危险因素。早期发现和预防策略对于减轻COVID-19患者SPI的短期后果至关重要。关键词:COVID-19;继发性肺部感染;死亡率;风险因素
Predictive Factors and Impact of Secondary Pulmonary Infection on Mortality in Patients with Hypoxemic COVID-19 Pneumonia: A Retrospective Cohort Study
Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19.
Objective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients.
Materials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI.
Results: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p<0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p<0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients.
Conclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients.
Keywords: COVID-19; Secondary pulmonary infection; Mortality; Risk factors