Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Ann Palliat Med. 2021 Mar;10(3):2859-2868. doi: 10.21037/apm-20-1575. Epub 2021 Feb 5.
Coronavirus disease 2019 (COVID-19) is a potentially life-threatening contagious disease which has spread all over the world. Risk factors associated with the clinical outcomes of COVID-19 pneumonia in intensive care unit (ICU) have not yet been well determined.
This was a retrospective, single-centered, observational study, in which 47 patients with confirmed COVID-19 were consecutively enrolled from February 24 to April 5, 2020. The patients were registered from the ICU of Leishenshan Hospital in Wuhan, China. Clinical characteristics and outcomes were collected and compared between survivors and non-survivors. Multivariable logistic regression was performed to analyze the risk factors of death in patients with COVID-19.
The study cohort included 47 adult patients with an average age of 70.55±12.52 years, and 30 (63.8%) patients were men. Totally 15 (31.9%) patients died. When compared to survivors, nonsurvivors showed a higher proportion of septic shock [6 (40%) patients vs. 3 (9.4%) patients], disseminated intravascular coagulation [3 (21.4%) vs. 0], and had higher score of APACHE II (25.07±8.03 vs. 15.56±5.95), CURB-65 {3 [2-4] vs. 2 [1-3]}, Sequential Organ Failure Assessment (SOFA) {7 [5-9] vs. 3 [1-6]}, higher level of D-dimer {5.74 [2.32-18] vs 2.05 [1.09-4.00]} and neutrophil count {9.4 [7.68-14.54] vs. 5.32 [3.85-9.34]}. SOFA score (OR 1.47; 95% CI: 1.01-2.13; P=0.0042) and the lymphocyte count (OR 0.02; 95% CI: 0.00-0.86; P=0.042) on admission were independently risk factors for mortality. Patients with higher lymphocyte count (>0.63×109 /L) and lower SOFA score (≤4) on admission had a significantly better prognosis than those with lower lymphocyte count (≤0.63×109 /L) and higher SOFA score (>4) in overall survival.
Higher SOFA score and lower lymphocyte count at admission were connected with poor prognosis of patients with COVID-19 in ICU. Lymphocyte count may serve as a promising prognostic biomarker.
2019 年冠状病毒病（COVID-19）是一种具有潜在生命威胁的传染性疾病，已在全球范围内传播。与 COVID-19 肺炎在重症监护病房（ICU）的临床结局相关的危险因素尚未得到很好的确定。
这是一项回顾性、单中心、观察性研究，其中连续纳入了 2020 年 2 月 24 日至 4 月 5 日从中国武汉雷神山医院 ICU 确诊的 47 例 COVID-19 患者。收集并比较了幸存者和非幸存者的临床特征和结局。采用多变量逻辑回归分析 COVID-19 患者死亡的危险因素。
研究队列包括 47 名平均年龄为 70.55±12.52 岁的成年患者，其中 30 名（63.8%）为男性。共有 15 名（31.9%）患者死亡。与幸存者相比，非幸存者中出现感染性休克的比例更高[6 名（40%）患者比 3 名（9.4%）患者]，弥散性血管内凝血[3 名（21.4%）比 0 名]，且 APACHE II 评分更高[25.07±8.03 比 15.56±5.95]，CURB-65[3[2-4]比 2[1-3]]，序贯器官衰竭评估（SOFA）[7[5-9]比 3[1-6]]，D-二聚体水平更高[5.74[2.32-18]比 2.05[1.09-4.00]]，中性粒细胞计数更高[9.4[7.68-14.54]比 5.32[3.85-9.34]]。SOFA 评分（OR 1.47；95%CI：1.01-2.13；P=0.0042）和入院时淋巴细胞计数（OR 0.02；95%CI：0.00-0.86；P=0.042）是死亡的独立危险因素。入院时淋巴细胞计数较高（>0.63×109/L）和 SOFA 评分较低（≤4）的患者总体生存率明显优于淋巴细胞计数较低（≤0.63×109/L）和 SOFA 评分较高（>4）的患者。
入院时 SOFA 评分较高和淋巴细胞计数较低与 COVID-19 患者在 ICU 的预后不良有关。淋巴细胞计数可能是一种有前途的预后生物标志物。
