Abstract

Background

The pandemic state caused by SARS CoV-2 came to overburden all levels of healthcare, including Primary Care. In Portugal, most patients were followed in ambulatory, monitored by phone calls or face-to-face visits by their General Practitioner.

Objective

The aim was to characterize the pathway of COVID-19 outpatients in Primary Care and establish the risk factors that mostly influences the need for hospitalization or death during the follow-up.

Methods

A retrospective cohort study was established, based on the official Portuguese dataset of the first wave between March 2^nd and June 30^th 2020. The predictive effects of variables, including age, gender, residency and clinical features, were analysed using Cox regression analysis.

Results

A total of 38,545 patients infected with SARS-CoV-2 was included for analysis (56.3% female), with a median age of 47 years old. There were 4,327 hospitalized patients, 253 in intensive care units and 1,153 deaths. Females present lower risk of hospitalization (HR = 0.78; 95% CI: 0.73–0.82; P < 0.001) and age is associated with higher risk (HR = 7.08; 95% CI: 6.68–7.50; P < 0.001), as well as the presence of at least one comorbidity (HR = 7.03; 95% CI: 6.43–7.69; P < 0.001). Multivariate analysis showed that cardiovascular disease, diabetes, smoking, obesity, chronic kidney disease, cancer, chronic obstructive pulmonary disease, HIV and other immunodeficiencies, transplant or immunosuppression, haematological disorders, neurological disorders and liver disease increased the risk of hospitalization.

Conclusion

Male gender, age and the presence of comorbidities are the main determinants for hospitalization and death. These COVID-19 patients should receive a higher attention when they come to primary care for assistance.

中文翻译：

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葡萄牙初级保健中随访的 COVID-19 患者：基于国家病例系列的回顾性队列研究

摘要

背景

由 SARS CoV-2 引起的大流行状态使各级医疗保健负担过重，包括初级保健。在葡萄牙，大多数患者在门诊进行随访，由他们的全科医生通过电话或面对面访问进行监测。

客观的

目的是描述初级保健中 COVID-19 门诊患者的路径，并确定在随访期间主要影响住院或死亡需要的风险因素。

方法

^{基于 2020 年 3 月 2日}至 6 月 30^日第一波葡萄牙官方数据集建立了一项回顾性队列研究。使用 Cox 回归分析分析了变量的预测效果，包括年龄、性别、居住地和临床特征。

结果

共有 38,545 名感染 SARS-CoV-2 的患者被纳入分析（56.3% 为女性），中位年龄为 47 岁。住院患者4327人，重症监护病房253人，死亡1153人。女性住院风险较低（HR = 0.78；95% CI：0.73-0.82；P < 0.001），年龄与较高风险相关（HR = 7.08；95% CI：6.68-7.50；P < 0.001），以及存在至少一种合并症（HR = 7.03；95% CI：6.43–7.69；P< 0.001)。多变量分析显示，心血管疾病、糖尿病、吸烟、肥胖、慢性肾病、癌症、慢性阻塞性肺病、艾滋病毒和其他免疫缺陷、移植或免疫抑制、血液系统疾病、神经系统疾病和肝脏疾病增加了住院风险。

结论

男性、年龄和合并症的存在是住院和死亡的主要决定因素。这些 COVID-19 患者在初级保健寻求帮助时应该受到更高的关注。