病情分级与院内制剂对新型冠状病毒感染患者28 d死亡风险的影响及其交互作用:一项回顾性队列研究

Impact and Interaction of Disease Severity and Hospital Preparations Associated with 28-Day Fatality Risk in COVID-19 Hospitalizations:A Retrospective Cohort Study

目的探究新型冠状病毒感染(简称新冠,COVID-19)住院患者28 d死亡风险的影响因素,并分析入院时病情分级与服用院内制剂的交互作用。方法回顾性收集江苏省中医院于2022年12月15日至2023年1月15日收治入院的,年龄18~90岁的新冠患者信息,排除入院48 h内死亡和未随访到结局的新冠住院患者信息。依据研究对象是否发生28 d死亡结局分为存活组和死亡组,对2组特征进行描述性分析,采用多因素Logistic回归分析新冠住院患者发生28 d死亡的影响因素,并通过叉生分析和层次回归法探讨入院时病情分级与住院期间是否服用院内制剂的相加交互作用。结果存活组和死亡组在入院时病情分级、住院期间服用院内制剂、住院期间使用激素、年龄、血小板、乳酸脱氢酶、尿素之间的差异具有统计学意义(P<0.05)。叉生分析和层次Logistic回归的结果显示,在未校正任何混杂因素时,入院时病情分级与服用院内制剂存在相加交互作用(RERI=-20.678,95%CI:-33.703~-7.652;APAI=-2.301,95%CI:-4.027~-0.575)且为拮抗相互作用(SI=0.279,95%CI:0.157~0.493);在校正了性别、年龄和临床特征,以及进一步校正实验室检查指标后,入院时病情分级与服用院内制剂仍存在相加交互作用(RERI=-5.972,95%CI:-10.564~-1.380;APAI=-2.205,95%CI:-4.131~-0.279),且为拮抗相互作用(SI=0.222,95%CI:0.095~0.523)。结论新冠患者在住院期间服用院内制剂可以降低28 d死亡风险,病情分级与使用院内制剂存在拮抗相加交互作用。

OBJECTIVE To identify the influence factors associated with 28-day fatality among COVID-19 hospitalizations and to analyze the interaction between the disease severity at admission and the use of hospital preparations.METHODS A retrospective review of records from COVID-19 hospitalizations aged 18 to 90 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023 were conducted.Patients who died or were lost to follow-up within 48 h of admission were excluded.Patients were divided into survival and death groups based on their 28-day fatality status.Descriptive statistics were used to characterize the two groups and multivariate logistic regression models were employed to identify factors influencing 28-day fatality risk.The interaction between the severity of illness at admission and the use of hospital preparations was explored through crossover analysis and hierarchical regression analysis.RESULTS Significant differences were observed between the survival and death groups in terms of severity of illness at admission,hospital preparations usage,steroid therapy,age,platelet count,lactate dehydrogenase levels,and urea(P<0.05).Crossover analysis and hierarchical logistic regression analysis revealed a significant antagonistic interaction between the severity of illness at admission and the use of hospital formulations both before adjustment(RERI=-20.678,95%CI:-33.703~-7.652;APAI=-2.301,95%CI:-4.027~-0.575)and after adjusting for gender,age,clinical characteristics and further adjusting for laboratory parameters(RERI=-5.972,95%CI:-10.564~-1.380;APAI=-2.205,95%CI:-4.131~-0.279),and it was an antagonistic interaction both before(SI=0.279,95%CI:0.157~0.493)and after adjustment(SI=0.222,95%CI:0.095~0.523).CONCLUSION The use of hospital preparations significantly reduces the 28-day fatality risk among COVID-19 hospitalizations and a clear antagonistic interaction was observed between the disease severity at admission and the use of hospital preparations.