Division of Pulmonary and Critical Care, Department of Medicine, BronxCare Health System, Bronx, New York.
Expert Rev Respir Med. 2021 Dec;15(12):1613-1617. doi: 10.1080/17476348.2022.1987885. Epub 2021 Oct 11.
Outcomes of patients with coronavirus disease (COVID-19) pneumonia, hypoxia, and an initial normal chest roentgenogram (CXR) are not well defined. This study aimed to analyze the factors associated with poor outcomes in these patients.
This retrospective study evaluated patients admitted with COVID-19 pneumonia, a CXR without infiltrates and hypoxemia requiring supplemental oxygen. Outcomes were compared based on D-dimer levels and included in-hospital mortality, need for mechanical ventilation, acute kidney injury, shock, and length of hospital stay.
We identified 115 patients, 31 (27%) had D-dimer levels above 4 times upper limit of normal on admission. Predictors of mortality included elevated D-dimers in hypoxic patients, use of mechanical ventilation, acute kidney injury, shock, and elevated admission serum sodium and lactic dehydrogenase.
Patients with COVID-19 and hypoxia on initial presentation despite a normal CXR had significant mortality rates, higher in those with elevated inflammatory markers. The use of inflammatory markers, such as D-dimer and serum ferritin levels, may assist in identifying patients with higher morbidity and mortality risks. Additional imaging with chest computed tomogram should be obtained if clinically indicated and avoidance of overreliance of a normal CXR in those patients.
患有新冠肺炎肺炎、缺氧且初始胸部 X 光片（CXR）正常的患者的预后尚不清楚。本研究旨在分析这些患者预后不良的相关因素。
本回顾性研究评估了因 COVID-19 肺炎、无浸润性 CXR 和需要补充氧气的低氧血症而入院的患者。根据 D-二聚体水平比较了预后，并包括住院死亡率、机械通气需求、急性肾损伤、休克和住院时间。
我们确定了 115 名患者，其中 31 名（27%）入院时 D-二聚体水平高于正常上限的 4 倍。缺氧患者 D-二聚体升高、使用机械通气、急性肾损伤、休克以及入院时血清钠和乳酸脱氢酶升高是死亡的预测因素。
尽管初始 CXR 正常，但表现为 COVID-19 缺氧的患者死亡率较高，炎症标志物升高的患者死亡率更高。使用 D-二聚体和血清铁蛋白等炎症标志物可能有助于识别发病率和死亡率较高的患者。如果临床需要，应进行胸部计算机断层扫描等额外的影像学检查，避免过度依赖这些患者的正常 CXR。
