意大利罗马新冠疫情第一波期间新冠患者的临床特征及死亡风险因素：一项单中心回顾性研究
Clinical characteristics and risk factors for mortality in COVID-19 patients during the first wave of the COVID-19 pandemic in Rome, Italy: a single-center retrospective study.
作者信息
Rando Emanuele, Oliva Alessandra, Cancelli Francesca, D'Agostino Claudia, Savelloni Giulia, Ciardi Maria Rosa, Ajassa Camilla, Siccardi Guido, Galardo Gioacchino, Mastroianni Claudio M
机构信息
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
出版信息
Infez Med. 2023 Mar 1;31(1):49-54. doi: 10.53854/liim-3101-7. eCollection 2022.
BACKGROUND
Since the beginning of 2020, the SARS-CoV-2 pandemic has become a serious public health problem. Numerous studies have highlighted the main clinical features of COVID-19, mainly the huge heterogeneity of the clinical manifestations that can vary from asymptomatic infection to serious viral pneumonia with a high mortality rate. The aim of this study was to analyze retrospectively the clinical characteristics and assess the risk factors for mortality in an Italian cohort of patients with COVID-19.
METHODS
Retrospective analysis including patients with COVID-19 admitted to the Infectious Diseases wards of Azienda Ospedaliera Universitaria Policlinico "Umberto 1", Rome, from March 2020 to May 2020. The data were part of an electronic anonymous web-based database processed by SIMIT (Italian Society of Infectious and Tropical Diseases).
RESULTS
258 patients were included in the analysis, and 34 (13.2%) died. The median age was 62 (IQR, 52-74), 106 (40%) were women, and 152 (60%) were males, 172 (66.7%) had at least one co-morbidity. The most common signs and symptoms were: fever [221 (85.6%)], cough [135 (52.3%)], and dyspnea [133 (51.5%)]. The PaO2/FiO2 ratio was often altered [352 (IQR, 308-424)]. Lymphopenia [lymphocyte counts, 875/μL (IQR, 640-1250)] and high levels of D-dimer [mg/dL, 874 (IQR, 484-1518)] were found. Non-survivors were older than survivors [median age, 74 (IQR, 67-85)] vs. 61 (QR, 51-72)], mostly men [25 (73.5%)] and more frequently with more than 2 comorbidities [21 (61.8%) vs. 94 (42.1%)]. In the multiple logistic regression model, the variables associated with in-hospital mortality were age [OR, 3.65 (95% CI, 1.22-10.89)], male gender [OR, 2.99 (95% CI, 1.18-7.54)], blood urea [OR, 2.76 (95% CI, 1.20-6.35)] and a low PaO2/FiO2 ratio [OR, 0.28 (95% CI, 0.12-0.62)].
CONCLUSION
The mortality rate in COVID-19 was 13,2%. The risk factors associated with in-hospital mortality were advanced age, male sex, increased blood urea, and the PaO2/FiO2 ratio reduction.
背景
自2020年初以来，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行已成为一个严重的公共卫生问题。众多研究突出了新型冠状病毒肺炎（COVID-19）的主要临床特征，主要是临床表现的巨大异质性，其可从无症状感染到具有高死亡率的严重病毒性肺炎不等。本研究的目的是回顾性分析意大利一组COVID-19患者的临床特征并评估死亡风险因素。
方法
回顾性分析纳入了2020年3月至2020年5月期间入住罗马“翁贝托一世”大学综合医院传染病病房的COVID-19患者。这些数据是由意大利传染病和热带病学会（SIMIT）处理的基于网络的电子匿名数据库的一部分。
结果
258例患者纳入分析，34例（13.2%）死亡。中位年龄为62岁（四分位间距，52 - 74岁），106例（40%）为女性，152例（60%）为男性，172例（66.7%）至少有一种合并症。最常见的体征和症状为：发热[221例（85.6%）]、咳嗽[135例（52.3%）]和呼吸困难[133例（51.5%）]。动脉血氧分压/吸入氧分数值（PaO2/FiO2）比值常发生改变[352例（四分位间距，308 - 424）]。发现淋巴细胞减少[淋巴细胞计数，875/μL（四分位间距，640 - 1250）]和D - 二聚体水平升高[mg/dL，874（四分位间距，484 - 1518）]。非幸存者比幸存者年龄更大[中位年龄，74岁（四分位间距，67 - 85岁）对61岁（四分位间距，51 - 72岁）]，大多为男性[25例（73.5%）]，且更频繁地患有超过2种合并症[21例（61.8%）对94例（42.1%）]。在多因素逻辑回归模型中，与院内死亡相关的变量为年龄[比值比（OR），3.65（95%置信区间，1.22 - 10.89）]、男性性别[OR，2.99（95%置信区间，1.18 - 7.54）]、血尿素[OR，2.76（95%置信区间，1.20 - 6.35）]和低PaO2/FiO2比值[OR，0.28（95%置信区间，0.12 - 0.62）]。
结论
COVID-19的死亡率为13.2%。与院内死亡相关的风险因素为高龄、男性性别、血尿素升高和PaO2/FiO2比值降低。
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