Yang Feihong, Zou Hao, Gan Jiaohong, Zhang Zhongxiang, Zhao Yan, Jiang Cheng, Xia Jian
Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, China.
Emerg Crit Care Med. 2021 Sep 15;1(1):29-36. doi: 10.1097/EC9.0000000000000001. eCollection 2021 Sep.
This study aimed to investigate the clinical characteristics of 21 deaths and evaluate potential factors affecting disease severity and mortality risk in patients with coronavirus disease (COVID-19).
This retrospective analysis assessed clinical data of 21 patients who died owing to COVID-19. Disease severity and mortality risk were assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II); Sepsis-related Organ Failure Assessment (SOFA); multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension and age (MuLBSTA); and pneumonia severity index (PSI) scores.
The mean age of the patients was 66 ± 14 years and 15 (71.4%) patients were men. Sixteen (76.2%) patients had chronic medical illnesses. Twelve (57.1%) patients were overweight. Decreased lymphocyte proportions were observed in 17 (81.0%) patients on admission. Elevated D-dimer levels were observed in 11 (52.4%) patients, and the levels significantly increased when pneumonia deteriorated. The initial APACHE II and SOFA scores demonstrated that 18 (85.7%) and 13 (61.9%) patients, respectively, were in the middle-risk level. MuLBSTA and PSI scores after admission were associated with higher risks of mortality in 13 (61.9%) patients. Most patients developed organ failure and subsequently died.
Older, overweight, male patients with a history of chronic illnesses and continuously decreased lymphocyte proportions and increased D-dimer levels might have higher risks of death owing to COVID-19. The combination of general scoring (SOFA) and pneumonia-specific scoring (MuLBSTA and PSI) systems after admission might be sensitive in assessing the mortality risk of patients with COVID-19 who are in critical condition.
本研究旨在调查21例死亡病例的临床特征，并评估影响冠状病毒病（COVID-19）患者疾病严重程度和死亡风险的潜在因素。
这项回顾性分析评估了21例因COVID-19死亡患者的临床数据。使用急性生理与慢性健康状况评分系统II（APACHE II）、脓毒症相关器官功能衰竭评估（SOFA）、多叶浸润、淋巴细胞减少、细菌合并感染、吸烟史、高血压和年龄（MuLBSTA）以及肺炎严重程度指数（PSI）评分来评估疾病严重程度和死亡风险。
患者的平均年龄为66±14岁，15例（71.4%）为男性。16例（76.2%）患者患有慢性疾病。12例（57.1%）患者超重。17例（81.0%）患者入院时淋巴细胞比例降低。11例（52.4%）患者D-二聚体水平升高，且肺炎恶化时该水平显著升高。初始APACHE II和SOFA评分显示，分别有18例（85.7%）和13例（61.9%）患者处于中危水平。入院后的MuLBSTA和PSI评分与13例（61.9%）患者的较高死亡风险相关。大多数患者出现器官衰竭并随后死亡。
年龄较大、超重、有慢性疾病史的男性患者，以及淋巴细胞比例持续降低和D-二聚体水平升高的患者，可能因COVID-19而有更高的死亡风险。入院后综合评分（SOFA）和肺炎特异性评分（MuLBSTA和PSI）系统可能对评估危重症COVID-19患者的死亡风险较为敏感。
