COVID-19 住院后家庭氧疗：多中心 OXFORD 研究结果。
Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study.
机构信息
Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
出版信息
Respir Care. 2024 Feb 28;69(3):281-289. doi: 10.4187/respcare.11436.
BACKGROUND
In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15-37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guidelines, little remains known about home oxygen requirements following hospitalization for COVID-19.
METHODS
This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020-September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19.
RESULTS
Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22-29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02-1.02]), higher body mass index (aOR 1.02 per kg/m [1.00-1.04]), diabetes (yes vs no, aOR 1.73 [1.46-2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19-4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51-208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66-0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%.
CONCLUSIONS
About one in 4 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.
背景
在大流行的最初几个月，在引入经过证实有效的治疗方法之前，COVID-19 住院患者中有 15-37%出院时需要接受家庭氧疗。在有证据支持的指南确定了治疗急性 COVID-19 的有效方法之后，对于 COVID-19 住院后家庭氧疗的需求知之甚少。
方法
这是一项回顾性、多中心队列研究，研究对象为 2020 年 10 月至 2021 年 9 月期间在 3 家学术医疗中心因 COVID-19 住院的患者。信息从索引住院和出院后 60 天的电子健康记录中提取。采用世界卫生组织 COVID-19 临床进展量表评分来识别重症 COVID-19 患者。
结果
在 517 名患者中（平均年龄 58 岁，47%为女性，42%为黑人，36%为西班牙裔，22%为重症 COVID-19），81%接受了全身皮质类固醇治疗，61%接受了瑞德西韦治疗，2.5%接受了托珠单抗治疗。约四分之一的患者出院时需要家庭氧疗（26%[95%CI 22-29%]）。年龄较大（调整后优势比[OR]每增加 5 岁为 1.02[95%CI 1.02-1.02]）、体重指数较高（调整后 OR 每增加 1kg/m2 为 1.02[1.00-1.04]）、糖尿病（是 vs 否，OR 1.73[1.46-2.02]）、重症 COVID-19（是 vs 中度，OR 3.19[2.19-4.64]）和接受全身皮质类固醇治疗（是 vs 否，OR 30.63[4.51-208.17]）与出院时需要家庭氧疗的几率增加相关。合并高血压（是 vs 否，OR 0.71[0.66-0.77]）与需要家庭氧疗的几率降低相关。在出院后 60 天内，有 50%的患者有脉搏血氧仪记录；在这组患者中，46%的患者停止了家庭氧疗。
结论
即使在有证据支持的指南确定了急性疾病的有效治疗方法之后，COVID-19 住院患者中仍有约四分之一的患者需要接受家庭氧疗。需要采取循证策略来减少 COVID-19 住院患者对家庭氧疗的需求。
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