在一家专门的新冠肺炎医院对危重症新冠肺炎患者的评估
Appraisal of Critically Ill COVID-19 Patients at a Dedicated COVID Hospital.
作者信息
Bhadade Rakesh, Harde Minal, deSouza Rosemarie, Kasbe Abhiram, Deshpande Charulata, Dave Sona, Joshi Mohan, Bharmal Ramesh, Madke Tushar
机构信息
Associate Professor, Medicine, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra.
Associate Professor, Anaesthesiology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra.
出版信息
J Assoc Physicians India. 2020 Sep;68(9):14-19.
PURPOSE
To study the pattern of severe COVID-19 to reduce morbidity and mortality.
METHODS
It was an observational cohort study for comprehensive clinical analysis of critically ill COVID-19 patients at a dedicated COVID public hospital.
RESULTS
Total 373(13.6%) patients were critically ill with 254(68.1%) males and 119(31.9%) females (including 25 pregnant) and death occurred in 69(18.5%) patients. Mean of parameters associated with critical COVID illness and having significant difference among dead and recovered were; age (47.08,p= 5.67E- 09), SpO2 (86.08), blood sugar(168.47,p= 1.86E-08), IL-6(210.5,p=0.0058) D-dimer(0.753,p= 0.00178). All the patients were given oxygen by non invasive technique, in 46(12.3%) intubation and invasive ventilation required. Use of hydroxychloroquin in 284(76.1%) (p=0.041,OR0.555,95%CI 0.314-0.981), lopinavir/ ritonavir in 283(75.9%) (p=4.222E-009,OR0.198, 95%CI0.114-0.345), tocilizumab in 124(33.2%) patients, (p=3.27E006, OR0.150, 95%CI0.063-0.358) were associated with recovery. Factors that influenced mortality were presence of co-morbidities (p=0.088,OR1.784,95%CI0.911-3.492), hypertension(p=0.0031,OR2.432,95% CI1.370 -4.318), low SpO2 (p=3.91E-010,OR0.017,95%CI0.002-0.137), high blood sugar(p=7.75E-009,OR8.514,95%CI 3.776-19.201), high LDH(p=0.00064,OR2.7 22,95%CI1.545-4.798) high ferritin(p=0.00014,OR4.606,95%CI 2.035-10.422), high D-dimer(p=2.85E-007,OR4.090,95%CI 2.371-7.056), low PFR(p=4.84E-008), and endotracheal intubation(p=3.14E-043,OR165.936,95%CI48.160-571.731). Using binary logistic regression, elevated IL-6(0.02441), low PFR(0.00082), and endotracheal intubation(2.04E-10) were statistically significant predictors of death.
CONCLUSION
"Happy Hypoxia", hyperglycemia, high inflammatory markers (IL-6, ferritin), and ARDS were hallmark of critical COVID-19, early detection of factors associated with severity and mortality and starting the multipronged management with oxygen in prone position, hydroxychloroquin, antiviral, methylprednisolone, anticoagulants, tocilizumab early may help in halting the worsening of COVID and reduce morbidity and mortality.
目的
研究重症新型冠状病毒肺炎（COVID-19）的模式以降低发病率和死亡率。
方法
这是一项观察性队列研究，对一家专门的COVID公立医院中危重症COVID-19患者进行全面临床分析。
结果
共有373例（13.6%）患者病情危重，其中男性254例（68.1%），女性119例（31.9%）（包括25例孕妇），69例（18.5%）患者死亡。与危重症COVID疾病相关且在死亡和康复患者之间有显著差异的参数均值为：年龄（47.08，p = 5.67E - 09），血氧饱和度（SpO2）（86.08），血糖（168.47，p = 1.86E - 08），白细胞介素-6（IL-6）（210.5，p = 0.0058），D-二聚体（0.753，p = 0.00178）。所有患者均采用无创技术吸氧，46例（12.3%）患者需要插管和有创通气。284例（76.1%）患者使用了羟氯喹（p = 0.041，OR 0.555，95%置信区间0.314 - 0.981），283例（75.9%）患者使用了洛匹那韦/利托那韦（p = 4.222E - 009，OR 0.198，95%置信区间0.114 - 0.345），124例（33.2%）患者使用了托珠单抗（p = 3.27E006，OR 0.150，95%置信区间0.063 - 0.358），这些与康复相关。影响死亡率的因素包括合并症的存在（p = 0.088，OR 1.784，95%置信区间0.911 - 3.492）、高血压（p = 0.0031，OR 2.432，95%置信区间1.370 - 4.318）、低SpO2（p = 3.91E - 010，OR 0.017，95%置信区间0.002 - 0.137）、高血糖（p = 7.75E - 009，OR 8.514，95%置信区间3.776 - 19.201）、高乳酸脱氢酶（LDH）（p = 0.00064，OR 2.722，95%置信区间1.545 - 4.798）、高铁蛋白（p = 0.00014，OR 4.606，95%置信区间2.035 - 10.422）、高D-二聚体（p = 2.85E - 007，OR 4.090，95%置信区间2.371 - 7.056）、低每分钟静息通气量（PFR）（p = 4.84E - 008）以及气管插管（p = 3.14E - 043，OR 165.936，95%置信区间48.160 - 571.731）。使用二元逻辑回归分析，升高的IL-6（0.02441）、低PFR（0.00082）和气管插管（2.04E - 10）是死亡的统计学显著预测因素。
结论
“快乐低氧血症”、高血糖、高炎症标志物（IL-6、铁蛋白）和急性呼吸窘迫综合征（ARDS）是重症COVID-19的特征，早期发现与严重程度和死亡率相关的因素，并尽早开始采取多方面管理措施，如俯卧位吸氧、使用羟氯喹、抗病毒药物、甲泼尼龙、抗凝剂、托珠单抗等，可能有助于阻止COVID病情恶化，降低发病率和死亡率。
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