239 例 COVID-19 危重症患者 60 天病死率的临床过程和预测因素：来自中国武汉的多中心回顾性研究。
Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China.
机构信息
Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China.
出版信息
Crit Care. 2020 Jul 6;24(1):394. doi: 10.1186/s13054-020-03098-9.
BACKGROUND
The global numbers of confirmed cases and deceased critically ill patients with COVID-19 are increasing. However, the clinical course, and the 60-day mortality and its predictors in critically ill patients have not been fully elucidated. The aim of this study is to identify the clinical course, and 60-day mortality and its predictors in critically ill patients with COVID-19.
METHODS
Critically ill adult patients admitted to intensive care units (ICUs) from 3 hospitals in Wuhan, China, were included. Data on demographic information, preexisting comorbidities, laboratory findings at ICU admission, treatments, clinical outcomes, and results of SARS-CoV-2 RNA tests and of serum SARS-CoV-2 IgM were collected including the duration between symptom onset and negative conversion of SARS-CoV-2 RNA.
RESULTS
Of 1748 patients with COVID-19, 239 (13.7%) critically ill patients were included. Complications included acute respiratory distress syndrome (ARDS) in 164 (68.6%) patients, coagulopathy in 150 (62.7%) patients, acute cardiac injury in 103 (43.1%) patients, and acute kidney injury (AKI) in 119 (49.8%) patients, which occurred 15.5 days, 17 days, 18.5 days, and 19 days after the symptom onset, respectively. The median duration of the negative conversion of SARS-CoV-2 RNA was 30 (range 6-81) days in 49 critically ill survivors that were identified. A total of 147 (61.5%) patients deceased by 60 days after ICU admission. The median duration between ICU admission and decease was 12 (range 3-36). Cox proportional-hazards regression analysis revealed that age older than 65 years, thrombocytopenia at ICU admission, ARDS, and AKI independently predicted the 60-day mortality.
CONCLUSIONS
Severe complications are common and the 60-day mortality of critically ill patients with COVID-19 is considerably high. The duration of the negative conversion of SARS-CoV-2 RNA and its association with the severity of critically ill patients with COVID-19 should be seriously considered and further studied.
背景
全球确诊病例和死亡的 COVID-19 重症患者人数不断增加。然而，重症患者的临床病程、60 天死亡率及其预测因素尚未完全阐明。本研究旨在确定 COVID-19 重症患者的临床病程、60 天死亡率及其预测因素。
方法
纳入来自中国武汉 3 家医院重症监护病房（ICU）的成年重症患者。收集人口统计学信息、入院前合并症、入院时实验室检查、治疗、临床结局以及 SARS-CoV-2 RNA 检测和血清 SARS-CoV-2 IgM 结果，包括从症状出现到 SARS-CoV-2 RNA 转为阴性的时间。
结果
在 1748 例 COVID-19 患者中，239 例（13.7%）重症患者入选。并发症包括急性呼吸窘迫综合征（ARDS）164 例（68.6%）、凝血功能障碍 150 例（62.7%）、急性心脏损伤 103 例（43.1%）和急性肾损伤（AKI）119 例（49.8%），分别于症状出现后 15.5、17、18.5 和 19 天发生。49 例重症存活患者中，SARS-CoV-2 RNA 转阴中位时间为 30（范围 6-81）天。共有 147 例（61.5%）患者在 ICU 入院后 60 天内死亡。从 ICU 入院到死亡的中位时间为 12（范围 3-36）天。Cox 比例风险回归分析显示，年龄大于 65 岁、入院时血小板减少、ARDS 和 AKI 独立预测 60 天死亡率。
结论
严重并发症常见，COVID-19 重症患者 60 天死亡率相当高。SARS-CoV-2 RNA 转阴时间及其与 COVID-19 重症患者严重程度的关系应引起重视并进一步研究。
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