在 COVID-19 疾病中，发病时的症状可预测预后。
Symptoms at disease onset predict prognosis in COVID-19 disease.
机构信息
Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
Libyan J Med. 2022 Dec;17(1):2010338. doi: 10.1080/19932820.2021.2010338.
The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33-55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, < 0.001), needed the intensive care unit more (9.7% vs 2.2%, = 0.005), non-invasive ventilation more (7.2% vs 1.5%, = 0.004), developed ARDS more (11.4% vs 2.2%, = 0.001) and needed longer time to recover (18.5 vs 16.7 days, = 0.003) compared to predominately non-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, = 0.01), dyspnea (OR = 4.91, < 0.001) and secondary bacterial infection (OR = 19.8, < 0.001) were independently associated with development of ARDS among COVID-19 patients. We identify COVID-19 subjects with dyspnea at disease onset who have a worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19.: COVID-19: Coronavirus disease 2019; ARDS: acute respiratory distress syndrome; IQR: interquartile range; ICU: intensive care unit; CDC: Chinese Center for Disease Control and Prevention.
新型冠状病毒病 2019（COVID-19）发病的主要临床表现为呼吸道症状，包括咳嗽、咳痰和呼吸困难。然而，相当一部分患者最初表现为非呼吸道症状，如发热、肌痛和腹泻。在这里，我们比较了发病时具有呼吸道症状和非呼吸道症状的患者的不同特征和结局。我们招募了来自湖南和广西 8 家医院呼吸科的核酸阳性严重急性呼吸综合征冠状病毒（SARS-CoV-2）患者。记录和分析了流行病学信息、临床表现、实验室检查结果和影像学特征、治疗方案和结局数据。所招募的 541 名患者的中位年龄为 43 岁（IQR，33-55）。在 541 名患者中，404 名（74.5%）患者的初始症状为呼吸道症状，而 137 名（25.5%）患者的初始症状为非呼吸道症状。呼吸道 COVID-19 患者发生继发性细菌感染的比例更高（8.7% vs 0.0%，<0.001），需要入住重症监护病房的比例更高（9.7% vs 2.2%，=0.005），需要接受无创通气的比例更高（7.2% vs 1.5%，=0.004），发生急性呼吸窘迫综合征（ARDS）的比例更高（11.4% vs 2.2%，=0.001），恢复时间更长（18.5 天 vs 16.7 天，=0.003）。多变量模型显示，年龄（OR=1.04，=0.01）、呼吸困难（OR=4.91，<0.001）和继发性细菌感染（OR=19.8，<0.001）与 COVID-19 患者发生 ARDS 独立相关。我们发现 COVID-19 患者发病时出现呼吸困难，其预后更差。我们还表明，年龄和继发性细菌感染与 COVID-19 患者的 ARDS 发展独立相关。
Zotero 插件