高血压对COVID-19患者临床结局的影响

Effect of hypertension on outcomes of patients with COVID-19

目的确定高血压对COVID-19患者预后的影响。方法我们对2020年1月1日~3月18日间就诊于洪湖市人民医院和南昌大学第一附属医院的共442例COVID-19患者(包括61例高血压患者和381例非高血压患者)进行了配对队列研究。为最大程度地减少年龄、性别和其他合并症等混淆因素的影响,我们排除了患有除高血压外其他合并症的患者,并将高血压和非高血压患者以1∶1的比例按相同年龄和性别进行配对,最终对32对(64例)患者的临床特征、实验室检查结果和临床结局进行了分析。结果与非高血压患者相比,高血压患者更容易发生细菌感染(P=0.002),中性粒细胞计数(P=0.007)、中性粒细胞/淋巴细胞比值(P=0.023)以及乳酸脱氢酶水平(P=0.035)更高。高血压患者更容易在胸部CT扫描中出现双侧斑片状阴影(P=0.012),使用抗生素(P=0.035)和皮质类固醇激素(P=0.035)的频率更高。结论高血压增加了COVID-19患者细菌感染的风险。患有高血压的COVID-19患者中性粒细胞计数和中性粒细胞/淋巴细胞比例更高,更加需要抗生素治疗,因此患有COVID-19的高血压患者应更加谨慎,避免细菌感染。

Objective To determine the impact of hypertension on the outcomes of patients with COVID-19.Methods This matched cohort study was conducted among a total 442 patients with COVID-19 admitted in Honghu People's Hospital and First Affiliated Hospital of Nanchang University between January 1 to March 18,2020,including 61 patients with hypertension and 381 normotensive patients.To minimize the effects of the confounding factors including age,gender and other comorbidities,we excluded patients with comorbidities other than hypertension,and matched the patients with and without hypertension for age and gender at a 1∶1 ratio.We analyzed the clinical characteristics,laboratory findings and clinical outcomes of in 32 matched pairs of patients with and without hypertension.Results Compared with the normotensive patients,COVID-19 patients with hypertension were more likely to develop bacterial infections(P=0.002)and had higher neutrophil counts(P=0.007),neutrophil/lymphocyte ratio(P=0.045),and lactate dehydrogenase levels(P=0.035).A greater proportion of patients had bilateral patchy opacities on chest CT(P=0.012)in the hypertension group than in the normotensive group.COVID-19 patients with hypertension groupwere more likely to receive antibiotics(P=0.035)and corticosteroid therapies(P=0.035).Conclusion Hypertension increases the risk of bacterial infection in patients with COVID-19.Hypertensive patients with COVID-19 have higher neutrophil counts and neutrophil/lymphocyte ratios and are more likely to require treatment with antibiotics.Hypertensive patients with COVID-19 should therefore take cautions to avoid bacterial infections.