COVID-19 患者需要或不需要重症或亚重症监护的临床特征和实验室生物标志物变化：一项比较研究。
Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study.
机构信息
Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
Information Technology System Unit, Azienda Ospedale Università di Padova, Padova, Italy.
出版信息
BMC Infect Dis. 2020 Dec 9;20(1):934. doi: 10.1186/s12879-020-05647-7.
BACKGROUND
Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not.
METHODS
This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups.
RESULTS
303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01).
CONCLUSIONS
The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.
背景
确定新型冠状病毒疾病（COVID-19）严重病例的危险因素有助于确定哪些患者可能受益于高级支持性治疗。本研究描述了因非危急临床症状而收治于普通病房的 COVID-19 患者，旨在分析转入重症监护病房（ICU）和/或亚重症监护病房（SICU）的患者与未转入的患者之间的差异。
方法
本观察性回顾性研究纳入了所有收治于传染病科的 COVID-19 患者。收集了临床、实验室、影像学和治疗数据。主要结局是住院期间需要转入 ICU 和/或 SICU 的复合指标。无需转科的患者定义为第 1 组，需要转入 ICU 和/或 SICU 的患者定义为第 2 组。比较两组患者的第 1、3 和最后一次测量的人口统计学、临床特征和实验室结果。
结果
共纳入 303 例患者。中位年龄为 62 岁。69 例（22.8%）符合主要结局，定义为第 2 组。总病死率为 6.8%。第 2 组患者主要为男性（76.8%比 55.1%，p<0.01），病死率较高（14.5%比 3.8%，p<0.01），高血压（72.4%比 44%，p<0.01）和糖尿病（31.9%比 21%，p=0.04）更为常见，更可能出现干咳（49.3%比 25.2%，p<0.01）。总体而言，入院时胸部 X 线检查显示肺炎表现者占 63.2%，第 2 组在住院期间更有可能出现异常影像学表现（72.7%比 17.2%，p=0.01）。入院时，第 2 组的中性粒细胞计数、天门冬氨酸转氨酶和 C 反应蛋白明显升高。第 3 次测量时，第 2 组的中性粒细胞计数、肝炎症标志物和 C 反应蛋白持续升高。第 1 组从入院到随访拭子转阴的时间更短（20 比 35 天，p<0.01）。
结论
存在合并症和持续观察到异常实验室发现应视为病情恶化的易患因素。
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