Laza Ruxandra, Dragomir Cristina, Musta Virgil Filaret, Lazureanu Voichita Elena, Nicolescu Narcisa Daniela, Marinescu Adelina Raluca, Paczeyka Roxana, Porosnicu Tamara Mirela, Bica-Porfir Valerica, Laitin Sorina Maria Denisa, Dragomir Ion, Ilie Constantin, Baditoiu Luminita Mirela
Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
Clinical Hospital of Infectious Diseases and Pneumophtisiology "Doctor Victor Babes", Timisoara, 300310, Romania.
Int J Gen Med. 2022 Mar 29;15:3417-3431. doi: 10.2147/IJGM.S359483. eCollection 2022.
Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients.
In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test.
The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94-487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01-1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24-1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38-4.35], p = 0.000; O saturation HR = 0.98 [0.96-0.99], p = 0.043; serum creatinine HR = 1.23 [1.08-1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42-6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97-7.33], p < 0.001; heart damage HR = 16.76 [1.49-188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92-208.19], p < 0.001.
Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.
罗马尼亚是受新型冠状病毒SARS-CoV-2引起的严重急性呼吸综合征影响最严重的欧洲国家之一，报告病例超过191万例，死亡超过59257例。本研究的目的是确定住院患者死亡的主要预测因素。
在2020年3月1日至2021年6月30日期间，进行了一项观察性、回顾性、随机、病例对照研究，其中包括139例在医院死亡的患者样本和275例病情好转或治愈出院的患者样本。通过对鼻咽和口咽分泌物进行逆转录聚合酶链反应（RT-PCR）来确诊COVID-19病例。采用逻辑回归、Cox回归以及对数秩（Mantel-Cox）检验比较生存曲线对统计数据进行分析。
最有力的逻辑回归模型确定了以下死亡的独立预测因素：凝血病病史HR = 30.73 [1.94 - 487.09]，p = 0.015；中性粒细胞百分比高HR = 1.09 [1.01 - 1.19]，p = 0.027；血氧降低HR = 53881.97 [1762.24 - 1647489.44]，p < 0.001。Cox回归确定了以下影响病例进展的因素：凝血病病史HR = 2.44 [1.38 - 4.35]，p = 0.000；血氧饱和度HR = 0.98 [0.96 - 0.99]，p = 0.043；血清肌酐HR = 1.23 [1.08 - 1.39]，p = 0.001；入院时呼吸困难HR = 2.99 [1.42 - 6.30]，p = 0.004；直接入住重症监护病房（ICU）HR = 3.803 [1.97 - 7.33]，p < 0.001；心脏损伤HR = 16.76 [1.49 - 188.56]，p = 0.022；血氧降低HR = 35.12 [5.92 - 208.19]，p < 0.001。
了解住院患者死亡的预测因素有助于未来优化COVID-19的分诊和治疗病例管理。
