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中国黄冈 COVID-19 重症患者死亡的危险因素:一项单中心多变量模式分析。

Risk factors for mortality in critically ill patients with COVID-19 in Huanggang, China: A single-center multivariate pattern analysis.

机构信息

Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, China.

Changsha Clinical Research Center for Kidney Disease, Changsha, China.

出版信息

J Med Virol. 2021 Apr;93(4):2046-2055. doi: 10.1002/jmv.26572. Epub 2020 Oct 14.

Abstract

To date, the coronavirus disease 2019 (COVID-19) has a worldwide distribution. Risk factors for mortality in critically ill patients, especially detailed self-evaluation indicators and laboratory-examination indicators, have not been well described. In this paper, a total of 192 critically ill patients (142 were discharged and 50 died in the hospital) with COVID-19 were included. Self-evaluation indicators including demographics, baseline characteristics, and symptoms and detailed lab-examination indicators were extracted. Data were first compared between survivors and nonsurvivors. Multivariate pattern analysis (MVPA) was performed to identify possible risk factors for mortality of COVID-19 patients. MVPA achieved a relatively high classification accuracy of 93% when using both self-evaluation indicators and laboratory-examination indicators. Several self-evaluation factors related to COVID-19 were highly associated with mortality, including age, duration (time from illness onset to admission), and the Barthel index (BI) score. When the duration, age increased by 1 day, 1 year, BI decreased by 1 point, the mortality increased by 3.6%, 2.4%, and 0.9% respectively. Laboratory-examination indicators including C-reactive protein, white blood cell count, platelet count, fibrin degradation products, oxygenation index, lymphocyte count, and d-dimer were also risk factors. Among them, duration was the strongest predictor of all-cause mortality. Several self-evaluation indicators that can simply be obtained by questionnaires and without clinical examination were the risk factors of all-cause mortality in critically ill COVID-19 patients. The prediction model can be used by individuals to improve health awareness, and by clinicians to identify high-risk individuals.

摘要

截至目前,2019 年冠状病毒病(COVID-19)已在全球范围内传播。危重症患者的死亡风险因素,特别是详细的自我评估指标和实验室检查指标,尚未得到很好的描述。本文共纳入 192 例 COVID-19 危重症患者(出院 142 例,院内死亡 50 例)。提取了自我评估指标,包括人口统计学、基线特征、症状和详细的实验室检查指标。首先比较了存活者和非存活者之间的数据。采用多变量模式分析(MVPA)来识别 COVID-19 患者死亡的可能风险因素。MVPA 在使用自我评估指标和实验室检查指标时达到了相对较高的 93%的分类准确率。几个与 COVID-19 相关的自我评估因素与死亡率高度相关,包括年龄、持续时间(从发病到入院的时间)和巴氏指数(BI)评分。当持续时间、年龄增加 1 天、1 年,BI 减少 1 分时,死亡率分别增加 3.6%、2.4%和 0.9%。实验室检查指标包括 C 反应蛋白、白细胞计数、血小板计数、纤维蛋白降解产物、氧合指数、淋巴细胞计数和 D-二聚体也是风险因素。其中,持续时间是所有原因死亡率的最强预测因素。几个可以通过问卷简单获得且无需临床检查的自我评估指标是 COVID-19 危重症患者全因死亡率的危险因素。预测模型可由个人使用以提高健康意识,由临床医生用于识别高风险个体。

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