Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People's Republic of China.
School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China.
Clin Interv Aging. 2020 Nov 10;15:2145-2153. doi: 10.2147/CIA.S268156. eCollection 2020.
This study is to investigate the risk prediction of severe or critical events of COVID-19 in older adults in China and provide the evidence to support the management of older adults with COVID-19.
The clinical data of older adults with COVID-19 admitted to the Shanghai Public Health Clinical Center during January 20, 2020 to March 16, 2020 were collected. The possible risk factors of severe or critical illness were investigated with Cox proportional hazards (PH) regression models for univariate and multivariate analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For the prediction indicators, optimum cut-off points were determined by calculating Youden's index. The efficacy of risk prediction of severe or critical illness was examined through the receiver operating characteristic (ROC) curve.
A total of 110 older adults with COVID-19 were included, in which 21 (19.1%) patients had severe or critical illness of COVID-19. Multivariable regression analysis showed that CD4 cells and D-dimer were independent risk factors. D-dimer, CD4 cells, and CD cells/D-dimer ratio with cut-off values of 0.65 (mg/L), 268 (cell/µL) and 431 were in the prediction of severe or critical illness of older adults with COVID-19. The AUC value of D-dimer, CD4 cells, CD4 cells/D-dimer ratio, the tandem combination and the parallel combination to predict severe or critical illness of the older adults with COVID-19 were 0.703, 0.804, 0.794, 0.812 and 0.694, respectively.
D-dimer and CD4 cells either by themselves or in combination have demonstrated predictive value in risk stratification as well as established the prognosis of severe or critical illness in older adults with COVID-19.
本研究旨在探讨中国老年 COVID-19 患者发生重症或危重症的风险预测因素，并为 COVID-19 老年患者的管理提供证据。
收集 2020 年 1 月 20 日至 3 月 16 日期间上海公共卫生临床中心收治的老年 COVID-19 患者的临床资料，采用 Cox 比例风险（PH）回归模型进行单因素和多因素分析，估计风险比（HR）和 95%置信区间（CI），筛选重症或危重症的可能危险因素。采用约登指数计算最佳截断值，绘制受试者工作特征（ROC）曲线评价预测指标对重症或危重症的预测效能。
共纳入 110 例老年 COVID-19 患者，其中 21 例（19.1%）患者发生重症或危重症 COVID-19。多因素回归分析显示，CD4 细胞和 D-二聚体是独立的危险因素。D-二聚体、CD4 细胞和 CD4 细胞/D-二聚体比值的截断值分别为 0.65（mg/L）、268（细胞/µL）和 431，用于预测老年 COVID-19 患者发生重症或危重症的风险。D-二聚体、CD4 细胞、CD4 细胞/D-二聚体比值、串联组合和并联组合预测老年 COVID-19 患者发生重症或危重症的 AUC 值分别为 0.703、0.804、0.794、0.812 和 0.694。
D-二聚体和 CD4 细胞无论是单独使用还是联合使用，都具有预测 COVID-19 老年患者重症或危重症风险分层和预后的价值。
