[重症新型冠状病毒肺炎患者发生感染性休克早期的危险因素]

[Risk factors for the early development of septic shock in patients with severe COVID-19].

作者信息

Glybochko P V, Fomin V V, Moiseev S V, Avdeev S N, Yavorovskiy A G, Brovko M Y, Umbetova K T, Aliev V A, Bulanova E L, Bondarenko I B, Volkova O S, Gaynitdinova V V, Gneusheva T Y, Dubrovin K V, Kapustina V A, Kraeva V V, Merzhoeva Z M, Nuralieva G S, Nogtev P V, Panasyuk V V, Politov M E, Popov A M, Popova E N, Raspopina N A, Royuk V V, Sorokin Y D, Trushenko N V, Khalikova E Y, Tsareva N A, Chikina S Y, Chichkova N V, Akulkina L A, Bulanov N M, Ermolova L A, Zykova A S, Kitbalyan A A, Moiseev A S, Potapov P P, Tao E A, Sholomova V I, Shchepalina A A, Yakovleva A A

机构信息

Sechenov First Moscow State Medical University (Sechenov University).

Sechenov First Moscow State Medical University(SechenovUniversity).

出版信息

Ter Arkh. 2020 Dec 26;92(11):17-23. doi: 10.26442/00403660.2020.11.000780.

DOI:10.26442/00403660.2020.11.000780

PMID:33720599

Abstract

AIM

In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.

MATERIALS AND METHODS

We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.

RESULTS

We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70).

CONCLUSION

The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

摘要

目的

在一项回顾性研究中，我们评估了与重症新型冠状病毒肺炎（COVID-19）患者脓毒性休克早期发展相关的因素。

材料与方法

我们收集了俄罗斯各地COVID-19医院提交给谢马什克第一莫斯科国立医科大学（谢马什克大学）联邦重症监护中心的重症监护病房患者的病历。需要机械通气的重症患者的脓毒性休克定义为需要使用血管升压药来维持血压。

结果

我们研究了1078例因呼吸支持而入住重症监护病房的重症COVID-19患者。其中男性611例，女性467例。平均年龄为61.0±13.7岁。525份病历（48.7%）来自莫斯科的医院，159份（14.7%）来自莫斯科地区，394份（36.5%）来自俄罗斯联邦58个地区的医院。613例（56.9%）患者通过PCR确诊SARS-CoV-2感染，其他病例根据临床表现和胸部CT扫描结果确诊。1078例患者中有214例（19.9%）发生脓毒性休克。在逻辑回归模型中，50岁以上患者发生脓毒性休克的风险高于年轻患者（比值比2.34；95%置信区间1.53-3.67；p<0.0001）。在SARS-CoV-2感染更严重的患者中，心血管疾病（包括冠心病和心房颤动）、2型糖尿病和恶性肿瘤的患病率增加。患有三种或更多种合并症的患者发生脓毒性休克的风险高于无任何慢性合并症的患者（比值比1.76；95%置信区间1.76-2.70）。