鉴定 COVID-19 肺炎院内死亡的风险因素——来自早期爆发的教训。

Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak.

机构信息

Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.

Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, 430014, China.

出版信息

BMC Infect Dis. 2021 Jan 25;21(1):113. doi: 10.1186/s12879-021-05814-4.

DOI:10.1186/s12879-021-05814-4

PMID:33494706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7829622/

Abstract

BACKGROUND

To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.

METHODS

A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed.

RESULTS

The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006-1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750-0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044-6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686-0.903, P = 0.001) indicated a better prognosis.

CONCLUSIONS

In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.

摘要

背景

研究 2019 年新型冠状病毒（COVID-19）肺炎住院患者的临床特征，并确定其住院死亡的独立危险因素。

方法

回顾性分析 2020 年 1 月 29 日至 3 月 20 日期间，在武汉市中心医院诊断为 COVID-19 肺炎的 156 例患者和 20 名健康个体的临床资料。收集并分析了流行病学参数、临床表现、基础疾病、实验室检查结果和疾病转归。

结果

所有纳入患者的中位年龄为 66 岁。101 例 COVID-19 患者至少存在 1 种基础疾病，其中高血压最常见，其次为心血管疾病和糖尿病。入院时最常见的症状是发热、咳嗽、呼吸困难和乏力。与存活病例相比，住院期间死亡的患者的血浆 D-二聚体、肌酐、肌酸激酶、乳酸脱氢酶、乳酸水平更高，淋巴细胞百分比（LYM [%]）、血小板计数和白蛋白水平更低。大多数患者接受了抗生素和抗病毒治疗。此外，60 例患者接受了皮质类固醇治疗，51 例患者接受了静脉注射免疫球蛋白治疗。44 例患者接受了无创通气，19 例患者接受了有创通气。呼吸衰竭是最常见的并发症（106 [67.9%]），其次是脓毒症（103 [66.0%]）、急性呼吸窘迫综合征（ARDS）（67 [42.9%]）和感染性休克（50 [32.1%]）。多变量回归分析表明，高龄（比值比[OR] = 1.098，95%置信区间[CI]：1.006-1.199，P = 0.037）、从发病到入院的时间较短（OR = 0.853，95% CI：0.750-0.969，P = 0.015）和入院时乳酸水平升高（OR = 2.689，95% CI：1.044-6.926，P = 0.040）是 COVID-19 感染住院死亡的独立危险因素。同时，入院时淋巴细胞百分比（LYM [%]）升高（OR = 0.787，95% CI：0.686-0.903，P = 0.001）提示预后较好。