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指定重症监护病房中2019冠状病毒病的危重症患者:临床特征及死亡预测因素

Critically Ill Patients with Coronavirus Disease 2019 in a Designated ICU: Clinical Features and Predictors for Mortality.

作者信息

Wang Zhao-Hua, Shu Chang, Ran Xiao, Xie Cui-Hong, Zhang Lei

机构信息

Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China.

Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China.

出版信息

Risk Manag Healthc Policy. 2020 Jul 20;13:833-845. doi: 10.2147/RMHP.S263095. eCollection 2020.

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic outbreak with a high mortality. Prognostic factors of critically ill patients with COVID-19 have not been fully elucidated yet.

METHODS

In the present study, 59 patients with COVID-19 from the intensive care unit of the Caidian Branch of Tongji Hospital were enrolled. Epidemiological, demographic, clinical, laboratory, radiological, treatment data, and clinical outcomes were collected. Prognostic factors were statistically defined.

RESULTS

Of the 59 patients studied (67.4±11.3 years), 38 patients were male, 51 had underlying diseases, and 41 patients died during admission. Compared with the survivors, the deceased patients were of older age, had more smoking history, severer fatigue, and diarrhea, a higher incidence of multiple organ injuries, more deteriorative lymphopenia and thrombocytopenia, remarkably impaired cellular immune response, and strengthened cytokine release. Age higher than 70 (OR=2.76, 95% CI=1.45-5.23), arrhythmia (OR=4.76, 95% CI=1.59-14.25), and a Sequential Organ Failure Assessment (SOFA) score above 4 (OR=5.16, 95% CI=1.29-20.55) were identified as risk factors for mortality of patients.

CONCLUSION

Critically ill COVID-19 patients aged higher than 70, arrhythmia, or a SOFA score above 4 have a high risk of mortality, and need prior medical intervention.

摘要

背景

2019冠状病毒病(COVID-19)是一场全球大流行疫情,死亡率很高。COVID-19重症患者的预后因素尚未完全阐明。

方法

在本研究中,纳入了来自同济医院蔡甸分院重症监护病房的59例COVID-19患者。收集了流行病学、人口统计学、临床、实验室、放射学、治疗数据及临床结局。对预后因素进行了统计学定义。

结果

在所研究的59例患者(年龄67.4±11.3岁)中,男性38例,51例有基础疾病,41例在住院期间死亡。与幸存者相比,死亡患者年龄更大,有更多吸烟史、更严重的乏力和腹泻,多器官损伤发生率更高,淋巴细胞减少和血小板减少更严重,细胞免疫反应明显受损,细胞因子释放增强。年龄大于70岁(OR=2.76,95%CI=1.45-5.23)、心律失常(OR=4.76,95%CI=1.59-14.25)和序贯器官衰竭评估(SOFA)评分高于4分(OR=5.16,95%CI=1.29-20.55)被确定为患者死亡的危险因素。

结论

年龄大于70岁、有心律失常或SOFA评分高于4分的COVID-19重症患者死亡风险高,需要提前进行医学干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f069/7381092/a92d2df18539/RMHP-13-833-g0001.jpg

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