预测入住重症监护病房的COVID-19患者预后的因素：利用临床、实验室和影像学特征
Factors Predicting Outcome in Intensive Care Unit-Admitted COVID-19 Patients: Using Clinical, Laboratory, and Radiologic Characteristics.
作者信息
Abkhoo Aminreza, Shaker Elaheh, Mehrabinejad Mohammad-Mehdi, Azadbakht Javid, Sadighi Nahid, Salahshour Faeze
机构信息
Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Crit Care Res Pract. 2021 Jul 7;2021:9941570. doi: 10.1155/2021/9941570. eCollection 2021.
PURPOSE
To investigate the factors contributing to mortality in coronavirus disease 2019 (COVID-19) patients admitted in the intensive care unit (ICU) and design a model to predict the mortality rate.
METHOD
We retrospectively evaluated the medical records and CT images of the ICU-admitted COVID-19 patients who had an on-admission chest CT scan. We analyzed the patients' demographic, clinical, laboratory, and radiologic findings and compared them between survivors and nonsurvivors.
RESULTS
Among the 121 enrolled patients (mean age, 62.2 ± 14.0 years; male, 82 (67.8%)), 41 (33.9%) survived, and the rest succumbed to death. The most frequent radiologic findings were ground-glass opacity (GGO) (71.9%) with peripheral (38.8%) and bilateral (98.3%) involvement, with lower lobes (94.2%) predominancy. The most common additional findings were cardiomegaly (63.6%), parenchymal band (47.9%), and crazy-paving pattern (44.4%). Univariable analysis of radiologic findings showed that cardiomegaly ( : 0.04), pleural effusion ( : 0.02), and pericardial effusion ( : 0.03) were significantly more prevalent in nonsurvivors. However, the extension of pulmonary involvement was not significantly different between the two subgroups (11.4 ± 4.1 in survivors vs. 11.9 ± 5.1 in nonsurvivors, : 0.59). Among nonradiologic factors, advanced age ( : 0.002), lower O saturation ( : 0.01), diastolic blood pressure ( : 0.02), and hypertension ( : 0.03) were more commonly found in nonsurvivors. There was no significant difference between survivors and nonsurvivors in terms of laboratory findings. Three following factors remained significant in the backward logistic regression model: O saturation (OR: 0.91 (95% CI: 0.84-0.97), : 0.006), pericardial effusion (6.56 (0.17-59.3), : 0.09), and hypertension (4.11 (1.39-12.2), : 0.01). This model had 78.7% sensitivity, 61.1% specificity, 90.0% positive predictive value, and 75.5% accuracy in predicting in-ICU mortality.
CONCLUSION
A combination of underlying diseases, vital signs, and radiologic factors might have prognostic value for mortality rate prediction in ICU-admitted COVID-19 patients.
目的
探讨影响入住重症监护病房（ICU）的2019冠状病毒病（COVID-19）患者死亡率的因素，并设计一个预测死亡率的模型。
方法
我们回顾性评估了入住ICU且入院时进行了胸部CT扫描的COVID-19患者的病历和CT图像。我们分析了患者的人口统计学、临床、实验室和影像学检查结果，并在幸存者和非幸存者之间进行了比较。
结果
在121例入组患者中（平均年龄62.2±14.0岁；男性82例（67.8%）），41例（33.9%）存活，其余患者死亡。最常见的影像学表现为磨玻璃影（GGO）（71.9%），外周（38.8%）及双侧（98.3%）受累，以下叶（94.2%）为主。最常见的其他表现为心脏增大（63.6%）、实质带（47.9%）和铺路石样改变（44.4%）。影像学表现的单因素分析显示，心脏增大（P=0.04）、胸腔积液（P=0.02）和心包积液（P=0.03）在非幸存者中明显更常见。然而，两个亚组之间肺部受累范围无显著差异（幸存者为11.4±4.1，非幸存者为11.9±5.1，P=0.59）。在非影像学因素中，高龄（P=0.002）、较低的血氧饱和度（P=0.01）、舒张压（P=0.02）和高血压（P=0.03）在非幸存者中更常见。幸存者和非幸存者在实验室检查结果方面无显著差异。在向后逻辑回归模型中，以下三个因素仍然显著：血氧饱和度（OR：0.91（95%CI：0.84-0.97），P=0.006）、心包积液（6.56（0.17-59.3），P=0.09）和高血压（4.11（1.39-12.2），P=0.01）。该模型预测ICU内死亡率的敏感性为78.7%，特异性为61.1%，阳性预测值为90.0%，准确性为75.5%。
结论
基础疾病、生命体征和影像学因素的综合可能对入住ICU的COVID-19患者死亡率预测具有预后价值。
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