成人COVID-19重症及危重症患者的临床特征分析

Clinical features of severe or critical ill patients with COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)重症及危重症患者的临床特征。方法对2020年1月~2020年3月湖北省洪湖市人民医院75例COVID-19重症及危重症患者临床资料进行回顾性分析。结果75例患者重型43例,危重型32例,男性41例(54.67),女性34例(45.33%),年龄58.1±15.9岁,49.3%患者有基础疾病史,主要临床表现为发热(78.67%)和咳嗽(70.67%)等。与重型患者比较,危重型患者在年龄>60岁患者比例、入院时WBC计数、hsCRP、PCT、凝血酶原时间、D二聚体、ALT、CRE、LDH、cTnI、NT-proBNP等均较重症组明显升高,有显著性统计学差异(P<0.05)。单因素logistic回归分析结果显示,年龄>60岁、WBC计数升高、hs-CRP升高、凝血酶原时间延长、D二聚体升高、NT-proBNP升高、cTnI升高是COVID-19危重型的相关因素(P均<0.05)。进一步多因素logistic回归分析结果显示,年龄>60岁(OR=8.165,95%CI 1.483,45.576,P=0.017),凝血酶原时间延长(OR=7.516,95%CI 2.568,21.998,P=0.006)和NT-proBNP升高(OR=6.194,95%CI 1.305,29.404,P=0.022)是COVID-19危重型的独立相关因素。结论年龄大于60岁、凝血酶原时间延长和NT-proBNP升高是COVID-19危重症患者的重要临床特征,可能为危重症患者的早期预警因素。

Objective To analyze the clinical features of severe or critical ill adult patients with coronavirus disease(COVID-19).Methods The clinical data of 75 patients with severe or critical COVID-19 in Honghu People's Hospital from January to March in 2020 were collected.Results Of the 75 patients with COVID-19 pneumonia,41 were male(54.67%)and 34 were female(45.33%)with a mean age of 67.53±12.37 years;43 patients had severe and 32 had critical COVID-19,and 49.3%of the patients had underlying diseases.The main clinical manifestations included fever(78.67%)and coughing(70.67%).Compared with the severe patients,the critically ill patients had higher proportions of patients over 60 years old with elevated white blood cell count,increased prothrombin time,and higher levels of hsCRP,PCT,D-dimer,ALT,LDH,cTnI and NT-proBNP.Univariate logistic regression analysis showed that an age over 60 years,leukocytosis,hs-CRP elevation,prolonged prothrombin time,and increased levels of D-dimer,NT-proBNP and cTnI were associated with severe COVID-19.Multivariate logistic regression showed that an age over 60 years(OR=8.165,95%CI:1.483-45.576,P=0.017),prolonged prothrombin time(OR=7.516,95%CI:2.568-21.998,P=0.006)and elevated NT-proBNP(OR=6.194,95%CI:1.305-29.404,P=0.022)were independent risk factors for critical type of COVID-19.Conclusion An age over 60 years,a prolonged prothrombin time and elevated NT-proBNP level are important clinical features of critically ill patients with COVID-19,and can be deemed as early warning signals for critical conditions of the disease.