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