Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
School of Medicine Veterinary and Life Sciences, Wolfson Medical School Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
J Transl Med. 2020 Sep 15;18(1):354. doi: 10.1186/s12967-020-02524-4.
Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure.
Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020-1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion.
Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 10/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4-8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2-19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1-4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1-4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0-11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2-20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1-5.1, p < 0.05) remained independently associated with 30-days mortality.
Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.
严重的 COVID-19 感染会导致全身炎症反应 (SIRS)。这种 SIRS 反应与围手术期观察到的变化相似，这些变化被认为与多器官衰竭的发展有关。
对英国格拉斯哥市在 COVID-19 大流行的最初 7 周期间（2020 年 3 月 17 日至 2020 年 5 月 1 日）入院的城市教学医院的患者的电子病历进行了检查，以获取常规临床、实验室和临床结果数据。年龄、性别、BMI 和出院或死亡证明时记录的 COVID-19 感染证据被认为是纳入的最低标准。
在符合纳入标准的 224 名患者中，52 名（23%）在入院后 30 天死亡。COVID-19 相关呼吸衰竭（75%）和多器官衰竭（12%）是记录的最常见死亡原因。年龄≥70 岁（p<0.001）、认知障碍的既往病史（p≤0.001）、既往谵妄（p<0.001）、临床虚弱评分>3（p<0.001）、高血压（p<0.05）、心力衰竭（p<0.01）、早期预警评分（NEWS）>4（p<0.01）、阳性 CXR（p<0.01）和随后的 COVID-19 拭子阳性（p≤0.001）与 30 天死亡率相关。CRP>80mg/L（p<0.05）、白蛋白<35g/L（p<0.05）、围手术期格拉斯哥预后评分（poGPS）（p<0.05）、淋巴细胞<1.5×10/L（p<0.05）、中性粒细胞与淋巴细胞比值（p≤0.001）、红细胞压积（<0.40 L/L（男性）/<0.37 L/L（女性））（p≤0.01）、尿素>7.5mmol/L（p<0.001）、肌酐>130mmol/L（p<0.05）和升高的尿素：白蛋白比值（<0.001）也与 30 天死亡率相关。多变量分析显示，年龄≥70 岁（OR 3.9，95%CI 1.4-8.2，p<0.001）、既往心力衰竭病史（OR 3.3，95%CI 1.2-19.3，p<0.05）、NEWS>4（OR 2.4，95%CI 1.1-4.4，p<0.05）、初始 CXR 阳性（OR 0.4，95%CI 0.2-0.9，p<0.05）和 poGPS（OR 2.3，95%CI 1.1-4.4，p<0.05）与 30 天死亡率独立相关。在那些 PCR COVID-19 阳性的患者中（n=122），年龄≥70 岁（OR 4.7，95%CI 2.0-11.3，p<0.001）、既往心力衰竭病史（OR 4.4，95%CI 1.2-20.5，p<0.05）和 poGPS（OR 2.4，95%CI 1.1-5.1，p<0.05）与 30 天死亡率独立相关。
年龄≥70 岁和围手术期格拉斯哥预后评分所测量的严重全身炎症与 COVID-19 感染住院患者的 30 天死亡率独立相关。
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