中国浙江 COVID-19 患者病情恶化的危险因素和临床特征：一项单中心回顾性研究。
Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single-centre, retrospective study.
机构信息
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou, 31003, Zhejiang Province, People's Republic of China.
Department of Infectious Disease, ShuLan Hangzhou Hospital, Hangzhou, Zhejiang Province, China.
出版信息
BMC Infect Dis. 2020 Dec 10;20(1):943. doi: 10.1186/s12879-020-05682-4.
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.
METHODS
A retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.
RESULTS
One hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P = 0.0001); sex (49% vs 77.6%, P = 0.0031); Body Mass Index (BMI) ([21.53-25.51] vs [23.28-27.01], P = 0.0339); hypertension (17.6% vs 57.1%, P < 0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P = 0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P < 0.0001); T lymphocyte count ([305-1178] vs [167.5-440], P = 0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P = 0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P = 0.0002); D2 dimer ([172-836] vs [408-953], P = 0.005), PCT ([0.03-0.07] vs [0.04-0.15], P = 0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P < 0.0001); AST ([16, 29] vs [18, 42], P = 0.0484); artificial liver therapy (2% vs 16.3%, P = 0.0148); and glucocorticoid therapy (64.7% vs 98%, P < 0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.
CONCLUSION
Deterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and artificial liver therapy, when necessary, may help reduce mortality in critically ill patients.
背景
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染于 2019 年 12 月开始在武汉爆发，并在中国和海外传播。为了确定与疾病进展相关的预测因素，我们评估了 SARS-CoV-2 感染恶化的临床危险因素。
方法
我们对 2020 年 1 月 19 日至 2 月 19 日期间在中国浙江确诊的 PCR 阳性 COVID-19（冠状病毒病 2019）住院患者进行了回顾性分析。我们系统地分析了患者的临床特征和临床恶化的预测因素。
结果
共纳入 100 例 COVID-19 患者，中位年龄 54 岁，其中 49 例（49%）为重症和危重症患者。年龄[36-58]岁比[51-70]岁，P=0.0001；性别（49%比 77.6%，P=0.0031）；体质量指数（BMI）[21.53-25.51]比[23.28-27.01]，P=0.0339）；高血压（17.6%比 57.1%，P<0.0001）；白细胞介素 6（IL-6）[6.42-30.46]比[16.2-81.71]，P=0.0001）；白细胞介素 10（IL-10）[2.16-5.82]比[4.35-9.63]，P<0.0001）；T 淋巴细胞计数[305-1178]比[167.5-440]，P=0.0001）；B 淋巴细胞计数[91-213]比[54.5-163.5]，P=0.0001）；白细胞计数[3.9-7.6]比[5.5-13.6]，P=0.0002）；D2 二聚体[172-836]比[408-953]，P=0.005）；降钙素原（PCT）[0.03-0.07]比[0.04-0.15]，P=0.0039）；C 反应蛋白（CRP）[3.8-27.9]比[17.3-58.9]，P<0.0001）；天门冬氨酸氨基转移酶（AST）[16，29]比[18，42]，P=0.0484）；人工肝治疗（2%比 16.3%，P=0.0148）；糖皮质激素治疗（64.7%比 98%，P<0.0001）与疾病严重程度相关。年龄和体重是疾病严重程度的独立危险因素。
结论
COVID-19 感染患者入院后病情迅速恶化。在我们的队列中，我们发现多种因素与 COVID19 的严重程度相关。早期检测和监测这些指标可能有助于降低疾病的进展。去除这些因素可能会阻止疾病的进展。此外，在危重症患者中，必要时给予氧疗、早期小剂量糖皮质激素治疗和人工肝治疗，可能有助于降低死亡率。
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