重症新型冠状病毒肺炎患者早期预警因素的分析

Early warning factors of severe patients with COVID⁃19

目的探讨重型和危重型新型冠状病毒肺炎(COVID-19)患者中早期预警因素.方法回顾性分析2020年1-3月广州市第八人民医院收治的普通型COVID-19患者73例,根据患者住院期间病情是否进展分为重症组(A组)和普通组(B组),比较两组患者入院淋巴细胞(lymphocyte,LYM)、C反应蛋白(C-reacitve protein,CRP)、血清淀粉样蛋白A(serum amyloid A protein,SAA)、乳酸(lactic acid,LAC)、嗜酸粒细胞(eosinophil,EOS)、乳酸脱氢酶(lactate dehydrogenase,LDH)、病毒载量、发病就诊时间指标及住院期间以上相关数值极值(最高或最低值),评估相关指标在普通型患者转化为重型、危重型的临床价值.结果A组入院时LYM、EOS均低于B组(P<0.05),住院期间A组LYM、EOS极值显著低于B组(均P<0.001);A组初始LAC与B组差异无统计学意义(P=0.095),住院期间A组LAC极值显著高于B组(P<0.001);A组初始CRP、SAA、LDH均高于B组(均P<0.05),住院期间A组以上指标极值均显著高于B组(均P<0.001);A组入院后冠状病毒核酸阳性率与B组无差异,住院期间复查咽拭子核酸仍为阳性A组高于B组(P=0.03);A组发病到就诊时间与B组对比差异无统计学意义;普通型患者转化为重型、危重型患者中位时间为(10.03±3.96)d.结论LYM、CRP、SAA、LAC、EOS、LDH在普通型转化为重型和危重型患者中有明显差异,其变化趋势可作为重型、危重型早期临床预警指标.

Objective To investigate the early warning factors of severe patients with COVID⁃19.Methods A retrospective analysis was conducted on 73 patients with common COVID⁃19 admitted in Eighth People′s Hospital of Guangzhou from January to March 2020.According to disease progression during hospitalization,patients were divided into severe group(group A)and common group(group B).Admission lymphocytes,C reactive protein,serum amyloid protein A,lactic acid,eosinophils,lactate dehydrogenase,viral load,incidence time and relative extreme value(highest or lowest value)in the two groups were compared.The clinical value of these indica⁃tors during disease progression was assessed.Results LYM and EOS in group A were lower than those in group B(P<0.05).During hospitalization,the extreme values of LYM and EOS in A group were significantly lower than those in group B(all P<0.001).There was no significant difference between group A and group B in terms of initial LAC,while during hospitalization,the extreme values of LAC in group A were significantly higher than those in group B(all P<0.001).Initial CRP,SAA and LDH in group A were higher than those in group B(all P<0.05)but during hospitalization,the extreme values of CRP,SAA and LDH in group A were significantly higher than those in group B(all P<0.001).There was no difference in positive rate of coronavirus nucleic acid between group A and B on admission but it was higher in group A than that in B group during hsopitalization(P=0.03).There was no statistical significance pertaining to time from onset to visiting the doctor and the median time of conversion to severe or critical cases was(10.03±3.96)days.Conclusion LYM,CRP,SAA,LAC,EOS and LDH have significant differences in the conversion from common to severe and critical patients,and the change trend can be used as early warning indicators for severe and critical cases.