College of Mathematics and Statistics & FJKLMAA, Fujian Normal University, Fuzhou, China.
Pulmonary and Critical Care Medicine, The Third People's Hospital of Dongguan City, Dongguan, China.
Front Cell Infect Microbiol. 2021 Aug 18;11:670823. doi: 10.3389/fcimb.2021.670823. eCollection 2021.
OBJECTIVE: To analyze the epidemiological history, clinical symptoms, laboratory testing parameters of patients with mild and severe COVID-19 infection, and provide a reference for timely judgment of changes in the patients' conditions and the formulation of epidemic prevention and control strategies. METHODS: A retrospective study was conducted in this research, a total of 90 patients with COVID-19 infection who received treatment from January 21 to March 31, 2020 in the Ninth People's Hospital of Dongguan City were selected as study subject. We analyzed the clinical characteristics of laboratory-confirmed patients with COVID-19, used the oversampling method (SMOTE) to solve the imbalance of categories, and established Lasso-logistic regression and random forest models. RESULTS: Among the 90 confirmed COVID-19 cases, 79 were mild and 11 were severe. The average age of the patients was 36.1 years old, including 49 males and 41 females. The average age of severe patients is significantly older than that of mild patients (53.2 years old 33.7 years old). The average time from illness onset to hospital admission was 4.1 days and the average actual hospital stay was 18.7 days, both of these time actors were longer for severe patients than for mild patients. Forty-eight of the 90 patients (53.3%) had family cluster infections, which was similar among mild and severe patients. Comorbidities of underlying diseases were more common in severe patients, including hypertension, diabetes and other diseases. The most common symptom was cough [45 (50%)], followed by fever [43 (47.8%)], headache [7 (7.8%)], vomiting [3 (3.3%)], diarrhea [3 (3.3%)], and dyspnea [1 (1.1%)]. The laboratory findings of patients also included leukopenia [13(14.4%)] and lymphopenia (17.8%). Severe patients had a low level of creatine kinase (median 40.9) and a high level of D-dimer. The median NLR of severe patients was 2.82, which was higher than that of mild patients. Logistic regression showed that age, phosphocreatine kinase, procalcitonin, the lymphocyte count of the patient on admission, cough, fatigue, and pharynx dryness were independent predictors of COVID-19 severity. The classification of random forest was predicted and the importance of each variable was displayed. The variable importance of random forest indicates that age, D-dimer, NLR (neutrophil to lymphocyte ratio) and other top-ranked variables are risk factors. CONCLUSION: The clinical symptoms of COVID-19 patients are non-specific and complicated. Age and the time from onset to admission are important factors that determine the severity of the patient's condition. Patients with mild illness should be closely monitored to identify those who may become severe. Variables such as age and creatine phosphate kinase selected by logistic regression can be used as important indicators to assess the disease severity of COVID-19 patients. The importance of variables in the random forest further complements the variable feature information.
目的:分析轻症和重症 COVID-19 感染患者的流行病学史、临床症状、实验室检测参数,为及时判断患者病情变化和制定防控策略提供参考。
方法:本研究采用回顾性研究方法,选取 2020 年 1 月 21 日至 3 月 31 日在东莞市第九人民医院接受治疗的 90 例 COVID-19 感染患者作为研究对象。我们分析了实验室确诊 COVID-19 患者的临床特征,使用过采样方法(SMOTE)解决类别不平衡问题,并建立了 Lasso-逻辑回归和随机森林模型。
结果:在 90 例确诊 COVID-19 病例中,79 例为轻症,11 例为重症。患者平均年龄为 36.1 岁,包括 49 名男性和 41 名女性。重症患者的平均年龄明显大于轻症患者(53.2 岁比 33.7 岁)。从发病到住院的平均时间为 4.1 天,实际住院平均时间为 18.7 天,这两个时间参数均长于轻症患者。90 例患者中有 48 例(53.3%)有家庭聚集性感染,轻症和重症患者之间相似。重症患者合并基础疾病的并发症更为常见,包括高血压、糖尿病等疾病。最常见的症状是咳嗽[45(50%)],其次是发热[43(47.8%)]、头痛[7(7.8%)]、呕吐[3(3.3%)]、腹泻[3(3.3%)]和呼吸困难[1(1.1%)]。患者的实验室检查还包括白细胞减少症[13(14.4%)]和淋巴细胞减少症(17.8%)。重症患者肌酸激酶水平较低(中位数 40.9),D-二聚体水平较高。重症患者的 NLR 中位数为 2.82,高于轻症患者。逻辑回归显示,年龄、肌酸激酶、降钙素原、患者入院时的淋巴细胞计数、咳嗽、乏力、咽干是 COVID-19 严重程度的独立预测因子。随机森林的分类预测显示了每个变量的重要性。随机森林的变量重要性表明,年龄、D-二聚体、NLR(中性粒细胞与淋巴细胞比值)等排名靠前的变量是危险因素。
结论:COVID-19 患者的临床症状是非特异性和复杂的。年龄和发病到入院的时间是决定患者病情严重程度的重要因素。应密切监测轻症患者,以识别可能转为重症的患者。逻辑回归选择的年龄和磷酸肌酸激酶等变量可作为评估 COVID-19 患者疾病严重程度的重要指标。随机森林中变量的重要性进一步补充了变量特征信息。
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