Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
Department of Medical Imaging, Xiaogan Central Hospital of Wuhan University of Science and Technology, Xiaogan, Hubei, China.
Theranostics. 2020 May 15;10(14):6372-6383. doi: 10.7150/thno.46833. eCollection 2020.
The risk factors for adverse events of Coronavirus Disease-19 (COVID-19) have not been well described. We aimed to explore the predictive value of clinical, laboratory and CT imaging characteristics on admission for short-term outcomes of COVID-19 patients. This multicenter, retrospective, observation study enrolled 703 laboratory-confirmed COVID-19 patients admitted to 16 tertiary hospitals from 8 provinces in China between January 10, 2020 and March 13, 2020. Demographic, clinical, laboratory data, CT imaging findings on admission and clinical outcomes were collected and compared. The primary endpoint was in-hospital death, the secondary endpoints were composite clinical adverse outcomes including in-hospital death, admission to intensive care unit (ICU) and requiring invasive mechanical ventilation support (IMV). Multivariable Cox regression, Kaplan-Meier plots and log-rank test were used to explore risk factors related to in-hospital death and in-hospital adverse outcomes. Of 703 patients, 55 (8%) developed adverse outcomes (including 33 deceased), 648 (92%) discharged without any adverse outcome. Multivariable regression analysis showed risk factors associated with in-hospital death included ≥ 2 comorbidities (hazard ratio [HR], 6.734; 95% CI; 3.239-14.003, p < 0.001), leukocytosis (HR, 9.639; 95% CI, 4.572-20.321, p < 0.001), lymphopenia (HR, 4.579; 95% CI, 1.334-15.715, p = 0.016) and CT severity score > 14 (HR, 2.915; 95% CI, 1.376-6.177, p = 0.005) on admission, while older age (HR, 2.231; 95% CI, 1.124-4.427, p = 0.022), ≥ 2 comorbidities (HR, 4.778; 95% CI; 2.451-9.315, p < 0.001), leukocytosis (HR, 6.349; 95% CI; 3.330-12.108, p < 0.001), lymphopenia (HR, 3.014; 95% CI; 1.356-6.697, p = 0.007) and CT severity score > 14 (HR, 1.946; 95% CI; 1.095-3.459, p = 0.023) were associated with increased odds of composite adverse outcomes. The risk factors of older age, multiple comorbidities, leukocytosis, lymphopenia and higher CT severity score could help clinicians identify patients with potential adverse events.
新型冠状病毒病(COVID-19)不良事件的危险因素尚未得到很好的描述。我们旨在探讨入院时的临床、实验室和 CT 影像学特征对 COVID-19 患者短期结局的预测价值。本多中心、回顾性、观察性研究纳入了 2020 年 1 月 10 日至 2020 年 3 月 13 日期间中国 8 个省 16 家三级医院收治的 703 例经实验室确诊的 COVID-19 患者。收集了人口统计学、临床、实验室数据、入院时的 CT 影像学表现和临床结局,并进行了比较。主要终点是住院期间死亡,次要终点是包括住院期间死亡、入住重症监护病房(ICU)和需要有创机械通气支持(IMV)在内的复合临床不良结局。多变量 Cox 回归、Kaplan-Meier 图和对数秩检验用于探讨与住院期间死亡和住院期间不良结局相关的危险因素。在 703 例患者中,55 例(8%)发生不良结局(包括 33 例死亡),648 例(92%)出院时无任何不良结局。多变量回归分析显示,与住院期间死亡相关的危险因素包括≥2 种合并症(危险比[HR],6.734;95%置信区间;3.239-14.003,p<0.001)、白细胞增多(HR,9.639;95%置信区间,4.572-20.321,p<0.001)、淋巴细胞减少(HR,4.579;95%置信区间,1.334-15.715,p=0.016)和 CT 严重程度评分>14(HR,2.915;95%置信区间,1.376-6.177,p=0.005),而年龄较大(HR,2.231;95%置信区间,1.124-4.427,p=0.022)、≥2 种合并症(HR,4.778;95%置信区间;2.451-9.315,p<0.001)、白细胞增多(HR,6.349;95%置信区间;3.330-12.108,p<0.001)、淋巴细胞减少(HR,3.014;95%置信区间;1.356-6.697,p=0.007)和 CT 严重程度评分>14(HR,1.946;95%置信区间;1.095-3.459,p=0.023)与复合不良结局的发生几率增加相关。年龄较大、多种合并症、白细胞增多、淋巴细胞减少和更高的 CT 严重程度评分等危险因素有助于临床医生识别可能发生不良事件的患者。