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Оценка факторов, влияющих на вероятность госпитализации больных COVID-19 с сопутствующей патологией, и разработка на их основе прогностической модели
Лизинфельд И.А., Пшеничная Н.Ю., Паролина Л.Е., Журавлев Г.Ю., Малеев В.В., Акимкин В.Г. Оценка факторов, влияющих на вероятность госпитализации больных COVID-19 с сопутствующей патологией, и разработка на их основе прогностической модели. Терапевтический архив. 2022;94(1):57–63. DOI: 10.26442/00403660.2022.01.201323
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Lizinfeld IA, Pshenichcnaya NYu, Parolina LE, Zhuravlev GYu, Maleev VV, Akimkin VG. Assessment of factors affecting the probability of hospitalization of COVID-19 patients with concomitant pathology and development of a prognostic model based on them. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):57–63. DOI: 10.26442/00403660.2022.01.201323
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Аннотация
Введение. В настоящее время значительное число пациентов с COVID-19 требуют лечения в условиях стационара. При этом предикторы госпитализации все еще четко не определены, в том числе у лиц с сопутствующей патологией.
Цель. Оценка факторов, влияющих на вероятность госпитализации больных COVID-19 с сопутствующей патологией, и разработка на их основе прогностической модели.
Материалы и методы. Проведено обсервационное ретроспективное когортное исследование 74 314 больных COVID-19 с сопутствующей патологией с марта по ноябрь 2020 г.
Результаты. На основании 16 факторов, среди которых возраст, пол, место установления диагноза, повышение температуры тела, ринит, потеря вкуса, одышка, сопутствующие заболевания сердечно-сосудистой, бронхолегочной системы, онкологические, эндокринные заболевания, разработана прогностическая модель вероятности стационарного лечения пациентов с COVID-19 и сопутствующей патологией.
Заключение. Построенная прогностическая модель продемонстрировала достаточную эффективность для оценки вероятности госпитализации пациентов с COVID-19 медицинскими специалистами.
Ключевые слова: коронавирус, COVID-19, госпитализация, сопутствующие заболевания, факторы госпитализации, прогноз
Цель. Оценка факторов, влияющих на вероятность госпитализации больных COVID-19 с сопутствующей патологией, и разработка на их основе прогностической модели.
Материалы и методы. Проведено обсервационное ретроспективное когортное исследование 74 314 больных COVID-19 с сопутствующей патологией с марта по ноябрь 2020 г.
Результаты. На основании 16 факторов, среди которых возраст, пол, место установления диагноза, повышение температуры тела, ринит, потеря вкуса, одышка, сопутствующие заболевания сердечно-сосудистой, бронхолегочной системы, онкологические, эндокринные заболевания, разработана прогностическая модель вероятности стационарного лечения пациентов с COVID-19 и сопутствующей патологией.
Заключение. Построенная прогностическая модель продемонстрировала достаточную эффективность для оценки вероятности госпитализации пациентов с COVID-19 медицинскими специалистами.
Ключевые слова: коронавирус, COVID-19, госпитализация, сопутствующие заболевания, факторы госпитализации, прогноз
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Introduction. Currently, a significant number of patients with COVID-19 require inpatient treatment. At the same time, predictors of hospitalization are still stable, including in persons with concomitant pathology.
Aim. Assessment of factors affecting the probability of hospitalization of COVID-19 patients with concomitant pathology and the development of a prognostic model based on them.
Materials and methods. An observational retrospective cohort study of 74 314 patients with COVID-19 with various comorbidities was carried out in the period from March to November 2020 in the Russian Federation.
Results. Based on 16 factors, including age, gender, place of diagnosis, fever, rhinitis, loss of taste, shortness of breath, concomitant diseases of the cardiovascular, bronchopulmonary system, oncological, endocrine diseases in patients included in the study, a prognostic model was developed. The need for inpatient treatment of patients with COVID-19 and comorbidities was determined.
Conclusion. The constructed predictive model has demonstrated sufficient efficiency to assess the likelihood of hospitalization of patients with COVID-19 by medical specialists.
Keywords: coronavirus, COVID-19, hospitalization, comorbidities, hospitalization factors, prognosis
Полный текст
Список литературы
1. Zou X, Li S, Fang M, et al. Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019. Crit Care Med. 2020;48(8):e657-65. DOI:10.1097/CCM.0000000000004411
2. Moreno-Pérez Ó, Andrés M, León-Ramirez JM, et al. The COVID-GRAM Tool for Patients Hospitalized With COVID-19 in Europe. JAMA Intern Med. 2021;181(7):1000-1.
DOI:10.1001/jamainternmed.2021.0491
3. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26]. Lancet Respir Med. 2020;8(5):475-81. DOI:10.1016/S2213-2600(20)30079-5
4. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. DOI:10.15585/mmwr.mm6915e3
5. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. DOI:10.1136/bmj.m1966
6. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 – Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):790-4. DOI:10.15585/mmwr.mm6925e1
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DOI:10.1016/S0140-6736(20)30566-3
8. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published correction appears in JAMA. 2021 May 25;325(20):2120]. JAMA. 2020;323(16):1574-81. DOI:10.1001/jama.2020.5394
9. Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020;288(4):469-76. DOI:10.1111/joim.13119
10. Cecconi M, Piovani D, Brunetta E, et al. Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548. DOI:10.3390/jcm9051548
11. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States, February 12 – March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. DOI:10.15585/mmwr.mm6912e2
12. Soares RCM, Mattos LR, Raposo LM. Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg. 2020;103(3):1184-90. DOI:10.4269/ajtmh.20-0483
13. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. DOI:10.1016/j.metabol.2020.154262
14. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-8. DOI:10.1016/j.jaci.2020.04.006
15. Sama IE, Ravera A, Santema BT, et al. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur Heart J. 2020;41(19):1810-17. DOI:10.1093/eurheartj/ehaa373
16. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70. DOI:10.1016/S0140-6736(20)31189-2
17. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA. 2021 Mar 16;325(11):1113]. JAMA. 2020;323(11):1061-9. DOI:10.1001/jama.2020.1585
18. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020 Mar 31;368:m1295]. BMJ. 2020;368:m1091. DOI:10.1136/bmj.m1091
19. Chen Y, Zhang K, Zhu G, et al. Clinical characteristics and treatment of critically ill patients with COVID-19 in Hebei. Ann Palliat Med. 2020;9(4):2118-30. DOI:10.21037/apm-20-1273
20. Zhu Z, Cai T, Fan L, et al. Clinical value of immune-inflammatory parameters to assess the severity of coronavirus disease 2019. Int J Infect Dis. 2020;95:332-9. DOI:10.1016/j.ijid.2020.04.041
2. Moreno-Pérez Ó, Andrés M, León-Ramirez JM, et al. The COVID-GRAM Tool for Patients Hospitalized With COVID-19 in Europe. JAMA Intern Med. 2021;181(7):1000-1.
DOI:10.1001/jamainternmed.2021.0491
3. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26]. Lancet Respir Med. 2020;8(5):475-81. DOI:10.1016/S2213-2600(20)30079-5
4. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. DOI:10.15585/mmwr.mm6915e3
5. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. DOI:10.1136/bmj.m1966
6. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 – Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):790-4. DOI:10.15585/mmwr.mm6925e1
7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054-62.
DOI:10.1016/S0140-6736(20)30566-3
8. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published correction appears in JAMA. 2021 May 25;325(20):2120]. JAMA. 2020;323(16):1574-81. DOI:10.1001/jama.2020.5394
9. Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020;288(4):469-76. DOI:10.1111/joim.13119
10. Cecconi M, Piovani D, Brunetta E, et al. Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548. DOI:10.3390/jcm9051548
11. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States, February 12 – March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. DOI:10.15585/mmwr.mm6912e2
12. Soares RCM, Mattos LR, Raposo LM. Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg. 2020;103(3):1184-90. DOI:10.4269/ajtmh.20-0483
13. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. DOI:10.1016/j.metabol.2020.154262
14. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-8. DOI:10.1016/j.jaci.2020.04.006
15. Sama IE, Ravera A, Santema BT, et al. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur Heart J. 2020;41(19):1810-17. DOI:10.1093/eurheartj/ehaa373
16. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70. DOI:10.1016/S0140-6736(20)31189-2
17. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA. 2021 Mar 16;325(11):1113]. JAMA. 2020;323(11):1061-9. DOI:10.1001/jama.2020.1585
18. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020 Mar 31;368:m1295]. BMJ. 2020;368:m1091. DOI:10.1136/bmj.m1091
19. Chen Y, Zhang K, Zhu G, et al. Clinical characteristics and treatment of critically ill patients with COVID-19 in Hebei. Ann Palliat Med. 2020;9(4):2118-30. DOI:10.21037/apm-20-1273
20. Zhu Z, Cai T, Fan L, et al. Clinical value of immune-inflammatory parameters to assess the severity of coronavirus disease 2019. Int J Infect Dis. 2020;95:332-9. DOI:10.1016/j.ijid.2020.04.041
________________________________________________
1. Zou X, Li S, Fang M, et al. Acute Physiology and Chronic Health Evaluation II Score as a Predictor of Hospital Mortality in Patients of Coronavirus Disease 2019. Crit Care Med. 2020;48(8):e657-65. DOI:10.1097/CCM.0000000000004411
2. Moreno-Pérez Ó, Andrés M, León-Ramirez JM, et al. The COVID-GRAM Tool for Patients Hospitalized With COVID-19 in Europe. JAMA Intern Med. 2021;181(7):1000-1.
DOI:10.1001/jamainternmed.2021.0491
3. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26]. Lancet Respir Med. 2020;8(5):475-81. DOI:10.1016/S2213-2600(20)30079-5
4. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. DOI:10.15585/mmwr.mm6915e3
5. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. DOI:10.1136/bmj.m1966
6. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 – Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):790-4. DOI:10.15585/mmwr.mm6925e1
7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054-62.
DOI:10.1016/S0140-6736(20)30566-3
8. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published correction appears in JAMA. 2021 May 25;325(20):2120]. JAMA. 2020;323(16):1574-81. DOI:10.1001/jama.2020.5394
9. Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020;288(4):469-76. DOI:10.1111/joim.13119
10. Cecconi M, Piovani D, Brunetta E, et al. Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548. DOI:10.3390/jcm9051548
11. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States, February 12 – March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. DOI:10.15585/mmwr.mm6912e2
12. Soares RCM, Mattos LR, Raposo LM. Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg. 2020;103(3):1184-90. DOI:10.4269/ajtmh.20-0483
13. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. DOI:10.1016/j.metabol.2020.154262
14. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-8. DOI:10.1016/j.jaci.2020.04.006
15. Sama IE, Ravera A, Santema BT, et al. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur Heart J. 2020;41(19):1810-17. DOI:10.1093/eurheartj/ehaa373
16. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70. DOI:10.1016/S0140-6736(20)31189-2
17. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA. 2021 Mar 16;325(11):1113]. JAMA. 2020;323(11):1061-9. DOI:10.1001/jama.2020.1585
18. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020 Mar 31;368:m1295]. BMJ. 2020;368:m1091. DOI:10.1136/bmj.m1091
19. Chen Y, Zhang K, Zhu G, et al. Clinical characteristics and treatment of critically ill patients with COVID-19 in Hebei. Ann Palliat Med. 2020;9(4):2118-30. DOI:10.21037/apm-20-1273
20. Zhu Z, Cai T, Fan L, et al. Clinical value of immune-inflammatory parameters to assess the severity of coronavirus disease 2019. Int J Infect Dis. 2020;95:332-9. DOI:10.1016/j.ijid.2020.04.041
Авторы
И.А. Лизинфельд1, Н.Ю. Пшеничная*2, Л.Е. Паролина1, Г.Ю. Журавлев2, В.В. Малеев2, В.Г. Акимкин2
1 ФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний» Минздрава России, Москва, Россия;
2 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, Москва, Россия
*natalia-pshenichnaya@yandex.ru
1 ФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний» Минздрава России, Москва, Россия;
2 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, Москва, Россия
*natalia-pshenichnaya@yandex.ru
________________________________________________
Irina A. Lizinfeld1, Natalia Yu. Pshenichcnaya*2, Liubov E. Parolina1, Grigorii Yu. Zhuravlev2, Viktor V. Maleev2 Vasiliy G. Akimkin2
1 National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia;
2 Central Research Institute of Epidemiology, Moscow, Russia
*natalia-pshenichnaya@yandex.ru
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