哮喘和代谢功能障碍与住院新型冠状病毒肺炎患者预后的关系
2024/09/29
摘要
背景：关于哮喘与2019冠状病毒病(COVID-19)严重程度之间的关系，一直存在争议。此前，代谢健康状况不佳与严重的COVID-19和哮喘炎症有关。
目的：研究哮喘与COVID-19结局之间的关联，以及这些关联是否被代谢综合症改变。
方法: 我们对2020年2月至2021年10月因COVID-19住院的成年患者进行了一项国际观察性队列研究。主要终点是住院死亡率。
结果: 该研究包括来自164家医院的27,660名患者，其中12,114 名（44%）为女性，中位（四分位距）年龄为63岁（51-75）。在调整了年龄、性别、吸烟、种族、民族、地理区域和 Elixhauser 合并症指数后，我们发现与无慢性肺病患者（对照组）相比，哮喘患者住院死亡的风险并不更高（校正比值比 [aOR]，0.97;95% CI，0.90-1.04;P = 0.40）。与对照组相比，哮喘患者需要更高的呼吸支持，需要补充氧气（aOR，1.07;95% CI，1.01-1.14;P = 0.02）、高流量鼻插管或无创机械通气（aOR， 1.06;95% CI，1.00-1.13;P = 0.04）和有创机械通气（aOR，1.09;95% CI，1.03-1.16;P = 0.003）。代谢综合征增加了哮喘患者的死亡风险，但在分层分析中观察到的关联程度与对照组相似(相互作用P值0.24)。
结论: 在这个国际住院 COVID-19 患者队列中，哮喘与死亡率无关，但与呼吸支持需求增加有关。尽管代谢功能障碍与COVID-19风险增加有关，但这些风险在患有或不患有哮喘的患者中是相似的。
The Association of Asthma and Metabolic Dysfunction With Outcomes of Hospitalized Patients With COVID-19.
Marija, Vukoja; Aysun.
Abstrast
Background: There have been conflicting results on the association of asthma with the severity of coronavirus disease 2019 (COVID-19). Poor metabolic health has been previously associated with both severe COVID-19 and inflammation in asthma.
Objective：To examine the association between asthma and COVID-19 outcomes and whether these associations are modified by metabolic syndrome.
Methods: We performed an international, observational cohort study of adult patients hospitalized for COVID-19 from February 2020 through October 2021. The primary outcome was hospital mortality.
Results: The study included 27,660 patients from 164 hospitals, 12,114 (44%) female, with a median (interquartile range) age of 63 years (51-75). After adjusting for age, sex, smoking, race, ethnicity, geographic region, and Elixhauser comorbidity index, we found that patients with asthma were not at greater risk of hospital death when compared with patients with no chronic pulmonary disease (controls) (adjusted odds ratio [aOR], 0.97; 95% CI, 0.90-1.04; P = 0.40). Patients with asthma, when compared with controls, required higher respiratory support identified by the need for supplemental oxygen (aOR, 1.07; 95% CI, 1.01-1.14; P = 0.02), high-flow nasal cannula or noninvasive mechanical ventilation (aOR, 1.06; 95% CI, 1.00-1.13; P = 0.04), and invasive mechanical ventilation (aOR, 1.09; 95% CI, 1.03-1.16; P = 0.003). Metabolic syndrome increased the risk of death in patients with asthma, but the magnitude of observed association was similar to controls in stratified analysis (interaction P value 0.24).
Conclusions：In this international cohort of hospitalized COVID-19 patients, asthma was not associated with mortality but was associated with increased need for respiratory support. Although metabolic dysfunction was associated with increased risks in COVID-19, these risks were similar for patients with or without asthma.
背景：关于哮喘与2019冠状病毒病(COVID-19)严重程度之间的关系，一直存在争议。此前，代谢健康状况不佳与严重的COVID-19和哮喘炎症有关。
目的：研究哮喘与COVID-19结局之间的关联，以及这些关联是否被代谢综合症改变。
方法: 我们对2020年2月至2021年10月因COVID-19住院的成年患者进行了一项国际观察性队列研究。主要终点是住院死亡率。
结果: 该研究包括来自164家医院的27,660名患者，其中12,114 名（44%）为女性，中位（四分位距）年龄为63岁（51-75）。在调整了年龄、性别、吸烟、种族、民族、地理区域和 Elixhauser 合并症指数后，我们发现与无慢性肺病患者（对照组）相比，哮喘患者住院死亡的风险并不更高（校正比值比 [aOR]，0.97;95% CI，0.90-1.04;P = 0.40）。与对照组相比，哮喘患者需要更高的呼吸支持，需要补充氧气（aOR，1.07;95% CI，1.01-1.14;P = 0.02）、高流量鼻插管或无创机械通气（aOR， 1.06;95% CI，1.00-1.13;P = 0.04）和有创机械通气（aOR，1.09;95% CI，1.03-1.16;P = 0.003）。代谢综合征增加了哮喘患者的死亡风险，但在分层分析中观察到的关联程度与对照组相似(相互作用P值0.24)。
结论: 在这个国际住院 COVID-19 患者队列中，哮喘与死亡率无关，但与呼吸支持需求增加有关。尽管代谢功能障碍与COVID-19风险增加有关，但这些风险在患有或不患有哮喘的患者中是相似的。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract 2024 Sep;12(9):2390-2398.e7.DOI:10.1016/j.jaip.2024.05.025.IF: 7.574)
(J Allergy Clin Immunol Pract 2024 Sep;12(9):2390-2398.e7.DOI:10.1016/j.jaip.2024.05.025.IF: 7.574)
The Association of Asthma and Metabolic Dysfunction With Outcomes of Hospitalized Patients With COVID-19.
Marija, Vukoja; Aysun.
Abstrast
Background: There have been conflicting results on the association of asthma with the severity of coronavirus disease 2019 (COVID-19). Poor metabolic health has been previously associated with both severe COVID-19 and inflammation in asthma.
Objective：To examine the association between asthma and COVID-19 outcomes and whether these associations are modified by metabolic syndrome.
Methods: We performed an international, observational cohort study of adult patients hospitalized for COVID-19 from February 2020 through October 2021. The primary outcome was hospital mortality.
Results: The study included 27,660 patients from 164 hospitals, 12,114 (44%) female, with a median (interquartile range) age of 63 years (51-75). After adjusting for age, sex, smoking, race, ethnicity, geographic region, and Elixhauser comorbidity index, we found that patients with asthma were not at greater risk of hospital death when compared with patients with no chronic pulmonary disease (controls) (adjusted odds ratio [aOR], 0.97; 95% CI, 0.90-1.04; P = 0.40). Patients with asthma, when compared with controls, required higher respiratory support identified by the need for supplemental oxygen (aOR, 1.07; 95% CI, 1.01-1.14; P = 0.02), high-flow nasal cannula or noninvasive mechanical ventilation (aOR, 1.06; 95% CI, 1.00-1.13; P = 0.04), and invasive mechanical ventilation (aOR, 1.09; 95% CI, 1.03-1.16; P = 0.003). Metabolic syndrome increased the risk of death in patients with asthma, but the magnitude of observed association was similar to controls in stratified analysis (interaction P value 0.24).
Conclusions：In this international cohort of hospitalized COVID-19 patients, asthma was not associated with mortality but was associated with increased need for respiratory support. Although metabolic dysfunction was associated with increased risks in COVID-19, these risks were similar for patients with or without asthma.
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高BMI的遗传易感性增加了早期呼吸道感染以及严重喘息和哮喘发作的风险
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重度哮喘患者中过敏性支气管肺曲霉病的患病率更高吗？
