Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Critical Care Medicine, Zhongda Hospital of Southeast University, Nanjing, China.
Am J Med Sci. 2020 Aug;360(2):120-128. doi: 10.1016/j.amjms.2020.05.038. Epub 2020 Jun 1.
We studied patients with coronavirus disease 2019 (COVID-19) infected by severe acute respiratory syndrome coronavirus 2, a virus that originated in Wuhan, China, and is spreading over the country including Jiangsu Province. We studied the clinical characteristics and therapies of severe cases in Jiangsu Province.
A multicenter retrospective cohort study was conducted to analyze clinical, laboratory data and treatment of 60 severe cases with COVID-19 infection in Jiangsu Province between January 24, 2020 and April 20, 2020. The improvement and deterioration subgroups were compared to identify predictors of disease progression.
A total of 653 infected cases with COVID-19 were reported in Jiangsu Province, of which 60 severe cases were included in this study. Up until April 20, 2020, the mortality of severe patients was 0%. The median age was 57 years. The average body mass index of these patients was 25 kg/m². White blood cell counts decreased in 45.0% of patients, lymphopenia in 63.3%, thrombocytopenia in 13.3% and procalcitonin levels in 88.3% of the patients were less than 0.5 ng/mL. There were no statistically significant differences in immunoglobulin therapy and GCs therapy between the improvement and deterioration subgroups. Logistic regression analysis identified higher levels of troponin T (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.00-1.08; P = 0.04), antiviral therapy with aerosol inhalation of interferon (OR: 6.33; 95% CI: 1.18-33.98; P = 0.03), and the application of non-invasive mechanical ventilation (OR: 1.99; 95%CI: 1.17-3.41; P = 0.01) as predictors of disease progression, whereas higher lymphocyte count (OR: 0.11; 95% CI: 0.02-0.57; P = 0.01) and early prone ventilation were associated with improvement (OR: 0.11; 95% CI: 0.01-0.98; P = 0.04).
COVID-19 infection had a low mortality rate in Jiangsu Province, China. The higher levels of troponin T and lower lymphocyte count were predictors of disease progression. Early prone ventilation may be an effective treatment for severe cases.
我们研究了感染严重急性呼吸综合征冠状病毒 2 （SARS-CoV-2）的 2019 年冠状病毒病（COVID-19）患者，该病毒源自中国武汉，并在中国各地传播，包括江苏省。我们研究了江苏省严重病例的临床特征和治疗方法。
对 2020 年 1 月 24 日至 4 月 20 日期间江苏省 60 例 COVID-19 感染严重病例的临床、实验室数据和治疗进行多中心回顾性队列研究。比较好转和恶化亚组，以确定疾病进展的预测因素。
江苏省共报告 653 例 COVID-19 感染病例，其中纳入本研究的严重病例 60 例。截至 2020 年 4 月 20 日，重症患者的死亡率为 0%。中位年龄为 57 岁。这些患者的平均体重指数为 25kg/m²。45.0%的患者白细胞计数下降，63.3%的患者淋巴细胞减少，13.3%的患者血小板减少，88.3%的患者降钙素原水平低于 0.5ng/mL。好转和恶化亚组之间免疫球蛋白治疗和 GCs 治疗无统计学差异。逻辑回归分析发现肌钙蛋白 T 水平较高（比值比[OR]：1.04；95%置信区间[CI]：1.00-1.08；P=0.04）、吸入干扰素抗病毒治疗（OR：6.33；95%CI：1.18-33.98；P=0.03）和应用无创机械通气（OR：1.99；95%CI：1.17-3.41；P=0.01）是疾病进展的预测因素，而较高的淋巴细胞计数（OR：0.11；95%CI：0.02-0.57；P=0.01）和早期俯卧位通气与改善相关（OR：0.11；95%CI：0.01-0.98；P=0.04）。
江苏省 COVID-19 感染死亡率较低。肌钙蛋白 T 水平较高和淋巴细胞计数较低是疾病进展的预测因素。早期俯卧位通气可能是治疗严重病例的有效方法。
