Zhang Jianguo, Huang Xing, Ding Daoyin, Zhang Jinhui, Xu Liusheng, Hu Zhenkui, Xu Wenrong, Tao Zhimin
Jiangsu Province Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China.
Department of Critical Care Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, China.
Front Med (Lausanne). 2021 Aug 16;8:666629. doi: 10.3389/fmed.2021.666629. eCollection 2021.
Amid the coronavirus disease 2019 (COVID-19) pandemic, we analyzed clinical characteristics of acute lung injury (ALI) in COVID-19 patients and reported their similarity and dissimilarity to those of non-COVID-19 patients in the intensive care unit (ICU). We reported on 90 COVID-19 and 130 non-COVID-19 ALI patients in the ICUs of multiple centers. Demographic data, medical histories, laboratory findings, and radiological images were analyzed and compared between the two cohorts and within each cohort between survivors and non-survivors. For ALI survivors, clinical characteristics before and after treatment were also compared. Aberrations in blood parameters, such as leukocytosis, neutrophilia, and thrombocytopenia, were observed in both cohorts. More characteristic abnormalities, including significantly higher red cell distribution width (RDW), C-reactive proteins, and lactic dehydrogenase (LDH) but lower troponin (TnT) and procalcitonin, were observed in the COVID-19 cohort than in the non-COVID-19 cohort, whereas D-dimer levels showed a similar elevation in both cohorts. The COVID-19 cohort also showed more diversified CT patterns where severe features such as consolidations and crazy paving patterns were more frequently observed. Multivariate analysis indicated that age, fever symptom, prothrombin time, procalcitonin, partial pressure of carbon dioxide, oxygenated hemoglobin, and crazy paving patterns in CT scans were independent risk factors associated with COVID-19. Comparison of ALI characteristics between COVID-19 and non-COVID-19 patients in the ICU setting provided insight into the pathogenesis of ALI induced by different risk factors, suggesting distinct treatment plans.
在2019冠状病毒病（COVID-19）大流行期间，我们分析了COVID-19患者急性肺损伤（ALI）的临床特征，并报告了其与重症监护病房（ICU）中非COVID-19患者的异同。我们报告了多个中心ICU中的90例COVID-19和130例非COVID-19的ALI患者。对两组患者以及每组中幸存者和非幸存者之间的人口统计学数据、病史、实验室检查结果和影像学图像进行了分析和比较。对于ALI幸存者，还比较了治疗前后的临床特征。在两组中均观察到血液参数异常，如白细胞增多、中性粒细胞增多和血小板减少。与非COVID-19队列相比，COVID-19队列中观察到更多特征性异常，包括红细胞分布宽度（RDW）、C反应蛋白和乳酸脱氢酶（LDH）显著升高，但肌钙蛋白（TnT）和降钙素原较低，而两组中D-二聚体水平均有类似升高。COVID-19队列的CT表现也更多样化，其中实变和铺路石样改变等严重特征更常见。多变量分析表明，年龄、发热症状、凝血酶原时间、降钙素原、二氧化碳分压、氧合血红蛋白以及CT扫描中的铺路石样改变是与COVID-19相关的独立危险因素。在ICU环境中比较COVID-19和非COVID-19患者的ALI特征，有助于深入了解不同危险因素所致ALI的发病机制，从而提出不同的治疗方案。
