中国湖北省两家中心的 2019 冠状病毒病（COVID-19）患者死亡的危险因素：一项回顾性分析。
Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis.
机构信息
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University, Fujian, China.
Teaching Hospital of Fujian Medical University, Fujian, China.
出版信息
PLoS One. 2021 Jan 28;16(1):e0246030. doi: 10.1371/journal.pone.0246030. eCollection 2021.
PURPOSE
Since the outbreak in late December 2019 in Wuhan, China, coronavirus disease-2019 (COVID-19) has become a global pandemic. We analyzed and compared the clinical, laboratory, and radiological characteristics between survivors and non-survivors and identify risk factors for mortality.
METHODS
Clinical and laboratory variables, radiological features, treatment approach, and complications were retrospectively collected in two centers of Hubei province, China. Cox regression analysis was conducted to identify the risk factors for mortality.
RESULTS
A total of 432 patients were enrolled, and the median patient age was 54 years. The overall mortality rate was 5.09% (22/432). As compared with the survivor group (n = 410), those in the non-survivor group (n = 22) were older, and they had a higher frequency of comorbidities and were more prone to suffer from dyspnea. Several abnormal laboratory variables indicated that acute cardiac injury, hepatic damage, and acute renal insufficiency were detected in the non-survivor group. Non-surviving patients also had a high computed tomography (CT) score and higher rate of consolidation. The most common complication causing death was acute respiratory distress syndrome (ARDS) (18/22, 81.8%). Multivariate Cox regression analysis revealed that hemoglobin (Hb) <90 g/L (hazard ratio, 10.776; 95% confidence interval, 3.075-37.766; p<0.0001), creatine kinase (CK-MB) >8 U/L (9.155; 2.424-34.584; p = 0.001), lactate dehydrogenase (LDH) >245 U/L (5.963; 2.029-17.529; p = 0.001), procalcitonin (PCT) >0.5 ng/ml (7.080; 1.671-29.992; p = 0.008), and CT score >10 (39.503; 12.430-125.539; p<0.0001) were independent risk factors for the mortality of COVID-19.
CONCLUSIONS
Low Hb, high LDH, PCT, and CT score on admission were the predictors for mortality and could assist clinicians in early identification of poor prognosis among COVID-19 patients.
目的
自 2019 年 12 月下旬中国武汉爆发以来，新型冠状病毒肺炎（COVID-19）已成为全球大流行疾病。本研究旨在分析和比较幸存者与非幸存者之间的临床、实验室和影像学特征，并确定死亡率的相关危险因素。
方法
回顾性收集中国湖北省两个中心的临床和实验室变量、影像学特征、治疗方法和并发症。采用 Cox 回归分析确定死亡率的相关危险因素。
结果
共纳入 432 例患者，中位年龄为 54 岁。总的死亡率为 5.09%（22/432）。与幸存者组（n=410）相比，非幸存者组（n=22）年龄更大，合并症更多，呼吸困难更常见。多项异常实验室变量提示，非幸存者组更易出现急性心脏损伤、肝损伤和急性肾功能不全。非幸存者的 CT 评分更高，实变比例更高。导致死亡的最常见并发症是急性呼吸窘迫综合征（ARDS）（18/22，81.8%）。多因素 Cox 回归分析显示，血红蛋白（Hb）<90 g/L（危险比，10.776；95%置信区间，3.075-37.766；p<0.0001）、肌酸激酶同工酶（CK-MB）>8 U/L（9.155；2.424-34.584；p=0.001）、乳酸脱氢酶（LDH）>245 U/L（5.963；2.029-17.529；p=0.001）、降钙素原（PCT）>0.5 ng/ml（7.080；1.671-29.992；p=0.008）和 CT 评分>10（39.503；12.430-125.539；p<0.0001）是 COVID-19 死亡率的独立危险因素。
结论
入院时 Hb 低、LDH、PCT 和 CT 评分高是死亡的预测因素，有助于临床医生早期识别 COVID-19 患者的不良预后。
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