信阳市新型冠状病毒肺炎重型/危重型早期危险因素筛选研究

Early identification and contribution factor analysis of severe coronavirus disease 2019 in Xinyang city of Henan province

目的探讨新型冠状病毒肺炎(简称新冠肺炎)重型/危重型患者的临床特征,分析影响病情严重程度的相关危险因素。方法采用回顾性分析方法对2020年1月22日至2020年2月28日在信阳市中心医院及信阳市第五人民医院集中隔离收治的110例新冠肺炎确诊患者的流行病学、实验室、影像学资料、临床治疗及影响病情严重程度的相关因素进行分析。结果110例新冠肺炎患者中位年龄为50(47,52)岁,男66例(60.0%),女44例(40.0%)。45例(40.9%)患者有基础疾病,108例(98.2%)患者有不同程度的发热,常见的临床表现有咳嗽(80.0%,88/110)、咳痰(33.6%,37/110)、疲劳(50.0%,55/110)、胸闷(41.8%,46/110)。临床分型:普通型组78例(70.9%),重型/危重型组32例(29.1%);两组患者的年龄[47(45,50)岁比55(50,59)岁,Z=–2.493]、基础疾病构成[27(34.6%)例比18(56.3%)例,χ^2=4.393]、淋巴细胞计数[1.2(0.9,1.5)×10^9/L比0.6(0.4,0.7)×10^9/L,Z=–7.26]、C反应蛋白[16.2(6.5,24.0)mg/L比45.3(21.8,69.4)mg/L,Z=–4.894]、凝血酶原时间[15(12,19)s比18(17,19)s,Z=–2.532]、D-二聚体[0.67(0.51,0.82)mg/L比0.98(0.80,1.57)mg/L,Z=–5.06]、血沉[38.0(20.8,59.3)mm/1 h比75.5(39.8,96.8)mm/1 h,Z=–3.851]、乳酸脱氢酶[218.0(175.0,252.3)U/L比325.0(276.5,413.5)U/L,Z=–5.539]、中性粒细胞计数[3.1(2.1,4.5)×10^9/L比5.5(3.7,9.1)×10^9/L,Z=–4.077]比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示:乳酸脱氢酶升高、C反应蛋白升高、凝血酶原时间延长、中性粒细胞计数升高与病情严重存在相关性。107例患者治愈出院,3例死亡,总死亡率2.7%。结论合并高龄、患有基础疾病、淋巴细胞计数降低、C反应蛋白升高、凝血酶原时间延长、D-二聚体升高、血沉升高的患者病情较重。乳酸脱氢酶、C反应蛋白、凝血酶原时间、中性粒细胞计数是患者病情严重的独立危险因素。

Objective To investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019(COVID-19). Methods The clinical symptoms, laboratory findings, radiologic data, treatment strategies,and outcomes of 110 COVID-19 patients were retrospectively analyzed in these hospitals from Jan 20, 2020 to Feb 28,2020. All patients were confirmed by fluorescence reverse transcription polymerase chain reaction. They were classified into a non-severe group and a severe group based on their symptoms, laboratory and radiologic findings. All patients were given antivirus, oxygen therapy, and support treatments. The severe patients received high-flow oxygen therapy, noninvasive mechanical ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation. The outcomes of patients were followed up until March 15, 2020. Contribution factors of severe patients were summarized from these clinical data. Results The median age was 50 years old, including 66 males(60.0%) and 44 females(40.0%).Among them, 45 cases(40.9%) had underlying diseases, and 108 cases(98.2%) had different degrees of fever. The common clinical manifestations were cough(80.0%, 88/110), expectoration(33.6%, 37/110), fatigue(50.0%, 55/110), and chest tightness(41.8%, 46/110). Based on classification criteria, 78(70.9%) non-severe patients and 32(29.1%) severe patients were identified. Significant difference of the following parameters was found between two groups(P<0.05): age was 47(45,50) years vs. 55(50, 59) years(Z=–2.493);proportion of patients with underlying diseases was 27(34.6%) vs. 18(56.3%)(χ2=4.393);lymphocyte count was 1.2(0.9, 1.5)×109/L vs. 0.6(0.4, 0.7)×109/L(Z=–7.26);C reactive protein(CRP) was16.2(6.5, 24.0) mg/L vs. 45.3(21.8, 69.4) mg/L(Z=–4.894);prothrombin time(PT) was 15(12, 19) seconds vs. 18(17,19) seconds(Z=–2.532);D-dimer was 0.67(0.51, 0.82) mg/L vs. 0.98(0.80, 1.57) mg/L(Z=–5.06);erythrocyte sedimentation rate(ESR) was 38.0(20.8, 59.3) mm/1 h vs. 75.5(39.8, 96.8) mm/1 h(Z=–3.851);lactate dehydrogenase(LDH) was 218.0(175.0, 252.3) U/L vs. 325.0(276.5, 413.5) U/L(Z=–5.539);neutrophil count was 3.1(2.1, 4.5)×109/L vs. 5.5(3.7, 9.1)×109/L(Z=–4.077). Multivariable logistic analysis showed that there was positive correlation in elevated LDH, CRP, PT, and neutrophil count with the severity of the disease. Currently, 107 patients were discharged and3 patients died. Total mortality was 2.7%. Conclusions Old age, underlying diseases, low lymphocyte count, elevated CPR, high D-dimer and ESR are relevant to the severity of COVID-19. LDH, CPR, PT and neutrophil count are independent risk factors for the prognosis of COVID-19.