Department of Geriatrics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
Department of Emergency Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ann Palliat Med. 2021 Jan;10(1):672-680. doi: 10.21037/apm-21-25.
The novel 2019 coronavirus (COVID-19) has largely abated in China; however, sporadic or imported cases are still a concern, while in other countries, the COVID-19 pandemic persists as a major health crisis.
All patients enrolled in this study were diagnosed with COVID-19 from February 21, 2020 to April 14, 2020 in Wuhan. We retrospectively analyzed the patients admitted to the ICU (137 patients) and general wards (114 patients) of Wuhan Leishenshan Hospital in China. The population characteristics, symptoms, and laboratory examination results between the patients in the ICU and those in the general wards were compared. Furthermore, the differences between the deceased patients in the ICU and those discharged from the ICU were compared.
There were significant differences between the two groups in terms of symptoms, including fever, shortness of breath, no presence of complications, presence of 1 complication, and presence of 3 or more complications (P<0.05). There were also significant differences between the patients in terms of the laboratory examination results including elevated urea nitrogen, creatinine, direct bilirubin, aspartate aminotransferase, total protein, albumin, creatine kinase, lactate dehydrogenase, procalcitonin, erythrocyte sedimentation rate, white blood cells, C-reactive protein, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, interleukin 6, interleukin 8, interleukin 10, interleukin 2 receptor, tumor necrosis factor-α, troponin I, phosphokinase isoenzyme-MB, and B-type natriuretic peptide; and decreased platelets, lymphocyte absolute value, and eosinophil absolute value (<0.05). There were 45 patients who died in ICU and 57 improved and discharged patients. There were significant differences between the two groups in the number of patients that had 1 complication and 3 or more complications (P<0.05). There were also significant differences in the laboratory examination results between the patients including elevated urea nitrogen, total bilirubin, direct bilirubin, aspartate aminotransferase, procalcitonin, white blood cells, interleukin 8, interleukin 10, phosphokinase isoenzyme-MB, and B-type natriuretic peptide; and decreased platelets and eosinophil absolute value (P<0.05).
Our findings highlight that the identified determinants may help to improve treatment of COVID-19 patients, to predict the risk of developing severe illness and to optimizing arrangement of health resources.
新型冠状病毒(COVID-19)在中国已基本得到控制,但仍有散发病例或输入性病例,而在其他国家,COVID-19 疫情仍在持续,是一项重大的健康危机。
本研究所有患者均于 2020 年 2 月 21 日至 2020 年 4 月 14 日在武汉雷神山医院被诊断为 COVID-19。我们回顾性分析了在武汉雷神山医院 ICU(137 例)和普通病房(114 例)收治的患者。比较了 ICU 患者和普通病房患者的人口特征、症状和实验室检查结果。此外,还比较了 ICU 中死亡患者和从 ICU 出院患者之间的差异。
两组患者在症状方面存在显著差异,包括发热、呼吸急促、无并发症、有 1 种并发症、有 3 种或更多种并发症(P<0.05)。在实验室检查结果方面也存在显著差异,包括尿素氮、肌酐、直接胆红素、天门冬氨酸氨基转移酶、总蛋白、白蛋白、肌酸激酶、乳酸脱氢酶、降钙素原、红细胞沉降率、白细胞、C 反应蛋白、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、D-二聚体、白细胞介素 6、白细胞介素 8、白细胞介素 10、白细胞介素 2 受体、肿瘤坏死因子-α、肌钙蛋白 I、磷酸激酶同工酶-MB 和 B 型钠尿肽升高;血小板、淋巴细胞绝对值和嗜酸性粒细胞绝对值降低(P<0.05)。ICU 中有 45 例患者死亡,57 例患者好转出院。两组患者中并发症 1 种和并发症 3 种或更多种的患者人数存在显著差异(P<0.05)。实验室检查结果也存在显著差异,包括尿素氮、总胆红素、直接胆红素、天门冬氨酸氨基转移酶、降钙素原、白细胞、白细胞介素 8、白细胞介素 10、磷酸激酶同工酶-MB 和 B 型钠尿肽升高;血小板和嗜酸性粒细胞绝对值降低(P<0.05)。
我们的研究结果表明,确定的这些决定因素可能有助于改善 COVID-19 患者的治疗效果,预测发生重症的风险,并优化卫生资源的配置。