Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
Pol Arch Intern Med. 2020 May 29;130(5):390-399. doi: 10.20452/pamw.15312. Epub 2020 Apr 24.
Coronavirus disease 2019 (COVID‑19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection spread worldwide.
The aim of the study was to identify the clinical characteristics and risk factors associated with severe incidence of SARS ‑CoV‑2 infection.
All adult patients (median [IQR] age, 52 [37-58] years) consecutively admitted to the Dabieshan Medical Center from January 30, 2020 to February 11, 2020 were collected and reviewed. Only patients diagnosed with COVID‑19 according to the World Health Organization interim guidance were included in this retrospective cohort study.
A total of 108 patients with COVID‑19 were retrospectively analyzed. Twenty‑five patients (23.1%) developed severe disease, and of those 12 patients (48%) died. Advanced age, comorbidities (most commonly hypertension), higher blood leukocyte count, neutrophil count, higher C‑reactive protein level, D‑dimer level, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were associated with greater risk of COVID‑19, and so were lower lymphocyte count and albumin level. Multivariable regress ion showed increasing odds of severe COVID‑19 associated with higher SOFA score (odds ratio [OR], 2.45; 95% CI, 1.302-4.608; P = 0.005), and lymphocyte count less than 0.8 × 109/l (OR, 9.017; 95% CI, 2.808-28.857; P <0.001) on admission. Higher SOFA score (OR, 2.402; 95% CI, 1.313-4.395; P = 0.004) on admission was identified as risk factor for in‑hospital death.
Lymphocytopenia and a higher SOFA score on admission could help clinicians to identify patients at high risk for developing severe COVID‑19. More related studies are needed in the future.
由严重急性呼吸系统综合症冠状病毒 2 型（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）在全球范围内传播。
本研究旨在确定与 SARS-CoV-2 感染严重程度相关的临床特征和危险因素。
本回顾性队列研究纳入了 2020 年 1 月 30 日至 2 月 11 日期间连续入住大别山医疗中心的所有成年患者（中位[IQR]年龄为 52[37-58]岁）。仅纳入符合世界卫生组织临时指南诊断为 COVID-19 的患者。
共回顾性分析了 108 例 COVID-19 患者。25 例（23.1%）患者发生重症疾病，其中 12 例（48%）死亡。高龄、合并症（最常见的是高血压）、较高的白细胞计数、中性粒细胞计数、较高的 C 反应蛋白水平、D-二聚体水平、急性生理学和慢性健康评估 II（APACHE II）评分和序贯器官衰竭评估（SOFA）评分与 COVID-19 风险增加相关，淋巴细胞计数和白蛋白水平较低也与 COVID-19 风险增加相关。多变量回归显示，SOFA 评分升高（比值比[OR]，2.45；95%置信区间，1.302-4.608；P=0.005）和入院时淋巴细胞计数<0.8×109/L（OR，9.017；95%置信区间，2.808-28.857；P<0.001）与重症 COVID-19 的发生几率增加相关。入院时较高的 SOFA 评分（OR，2.402；95%置信区间，1.313-4.395；P=0.004）是住院死亡的危险因素。
入院时的淋巴细胞减少和较高的 SOFA 评分有助于临床医生识别发生重症 COVID-19 的高危患者。未来需要进行更多的相关研究。
