Wang Qingqing, Yao Yumeng, Huang Zheyong, Cao Jiatian, Zhu Chouwen, Yu Kaihuan, Pan Jue, Hu Bijie
Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
J Thorac Dis. 2021 Aug;13(8):4723-4730. doi: 10.21037/jtd-20-1848.
Novel coronavirus disease (COVID-19) has spread globally and caused over 3 million deaths, posing great challenge on public health and medical systems. Limited data are available predictive factors for disease progression. We aim to assess clinical and radiological predictors for pulmonary aggravation in severe and critically ill COVID-19 patients.
Patients with confirmed COVID-19 in Renmin Hospital of Wuhan University, China, between Feb. 6th, 2020 and Feb. 21st, 2020 were retrospectively collected. Enrolled patients were divided into non-progression group and progression group based on initial and follow-up chest CTs. Clinical, laboratory, and radiological variables were analyzed.
During the study period, 162 patients were identified and a total of 126 patients, including 97 (77.0%) severe cases and 29 (23.0%) critically ill cases were included in the final analysis. Median age was 66.0 (IQR, 56.0-71.3) years. Median time from onset to initial chest CT was 15.0 (IQR, 12.0-20.0) days and median interval to follow-up was 7.0 (IQR, 5.0-7.0) days. Compared with those who did not progress (n=111, 88.1%), patients in the progression group (n=15, 11.9%) had significantly higher percentage of peak body temperature >38 °C (P=0.002), lower platelet count (P=0.011), lower CD4 T cell count (P=0.002), lower CD8 count (P=0.011), higher creatine kinase level (P=0.002), and lower glomerular filtration rate (P=0.018). On both univariate and multivariable analysis, only CD4 T cell count <200/µL was significant (OR, 6.804; 95% CI, 1.450-31.934; P=0.015) for predicting pulmonary progression.
Low CD4 T cell count predicts progression of pulmonary change in severe and critically ill patients with COVID-19.
新型冠状病毒肺炎（COVID-19）已在全球范围内传播，导致超过300万人死亡，给公共卫生和医疗系统带来了巨大挑战。关于疾病进展的预测因素的数据有限。我们旨在评估重症和危重症COVID-19患者肺部病情加重的临床和影像学预测因素。
回顾性收集2020年2月6日至2020年2月21日期间在中国武汉大学人民医院确诊为COVID-19的患者。根据初始和随访胸部CT将入选患者分为病情无进展组和病情进展组。对临床、实验室和影像学变量进行分析。
在研究期间，共识别出162例患者，最终分析纳入了126例患者，其中包括97例（77.0%）重症病例和29例（23.0%）危重症病例。中位年龄为66.0（四分位间距，56.0 - 71.3）岁。从发病到首次胸部CT的中位时间为15.0（四分位间距，12.0 - 20.0）天，到随访的中位间隔时间为7.0（四分位间距，5.0 - 7.0）天。与病情无进展的患者（n = 111，88.1%）相比，病情进展组的患者（n = 15，11.9%）体温峰值>38℃的百分比显著更高（P = 0.002），血小板计数更低（P = 0.011），CD4 T细胞计数更低（P = 0.002），CD8计数更低（P = 0.011），肌酸激酶水平更高（P = 0.002），肾小球滤过率更低（P = 0.018）。在单因素和多因素分析中，只有CD4 T细胞计数<200/µL对预测肺部病情进展具有显著性（比值比，6.804；95%置信区间，1.450 - 31.934；P = 0.015）。
低CD4 T细胞计数可预测重症和危重症COVID-19患者肺部病变的进展。
