新型冠状病毒肺炎患者近期危重事件相关因素研究

Relevant factors on short-term critical events in patients with corona virus disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)患者近期危重事件相关因素。方法选取2020年1月13日-2月15日COVID-19患者73例,根据是否采用高流量鼻导管氧疗、无创和有创辅助呼吸设备将患者分为危重组和非危重组。收集患者临床资料,分别记录入院当日、>1~≤4 d和>4~≤8 d 3个阶段14项实验室常规指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体(DD)、抗凝血酶活性(AT)、白细胞(WBC)计数、淋巴细胞(Ly)计数、血小板(PLT)计数、C-反应蛋白(CRP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血尿素氮(BUN)和血肌酐(Cr)]以及转归资料(观察至2020年3月6日)。比较2个组差异,分析COVID-19患者入院8 d内发生危重事件的影响因素。采用受试者工作特征(ROC)曲线评估影响因素对COVID-19患者近期危重事件发生的预测价值。结果危重组年龄、糖尿病史例数、死亡率均高于非危重组(P<0.05);危重组PT、DD、WBC计数、CRP、AST和BUN水平在3个阶段均高于非危重组(P<0.05);危重组APTT、Fg、TT、AT、Ly计数、PLT计数和Cr水平在不同阶段均与非危重组有统计学差异(P<0.05);2个组ALT水平在3个阶段差异均无统计学意义(P>0.05)。DD与PLT计数分别是近期危重事件发生的独立危险因素和独立保护因素。DD、PLT计数、DD+PLT计数预测危重事件发生的ROC曲线下面积(AUC)分别为0.820[95%可信区间(CI)为0.739~0.902]、0.764(95%CI为0.652~0.876)、0.809(95%CI为0.704~0.915),敏感性分别为67.4%、85.8%、67.9%,特异性分别为93.7%、60.7%、86.8%。结论DD和PLT计数与COVID-19患者近期危重事件的发生密切相关。

Objective To investigate the factors for short-term critical events in patients with corona virus disease 2019(COVID-19).Methods A total of 73 patients with COVID-19 were enrolled from January 13,2020 to February 15,2020.According to whether these patients used high flow nasal catheter oxygen therapy,noninvasive or invasive respiratory aids,the patients were classified into critical group and non-critical group.The clinical data were collected.The determination results of 14 routine indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),thrombin time(TT),D-dimer(DD),antithrombin activity(AT),white blood cell(WBC)count,lymphocyte(Ly)count,platelet(PLT)count,C-reactive protein(CRP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN)and serum creatinine(Cr)]at admission,>1-≤4 d and>4-≤8 d and clinical outcome data(observed until March 6,2020)were collected.The differences in the 2 groups were compared.The risk factors of short-term critical events in COVID-19 patients were analyzed by receiver operating characteristic(ROC)curve analysis.Results The age,number of diabetes mellitus cases and death rate in critical group were higher than those in non-critical group(P<0.05).The levels of PT,DD,WBC count,CRP,AST and BUN in critical group at the 3 stages were higher than those in non-critical group(P<0.05).For different courses,APTT,Fg,TT,AT,Ly count,PLT count and Cr had statistical significance between critical group and non-critical group(P<0.05).The level of ALT had no statistical significance at the 3 stages between the 2 groups(P>0.05).DD and PLT count were independent risk factors and independent protective factors for short-term critical events.ROC curve analysis indicated that the areas under curves(AUC)of DD,PLT count and DD+PLT count were 0.820[95%confidence interval(CI)0.739-0.902],0.764(95%CI 0.652-0.876)and 0.809(95%CI 0.704-0.915),respectively.The sensitivities of DD,PLT count and DD+PLT count were 67.4%,85.8%and 67.9%,and the specificities were 93.7%,60.7%and 86.8%,respectively.Conclusions DD and PLT count have relations with the occurrence of short-term critical events in patients with COVID-19.