34例重症新型冠状病毒肺炎患者临床特征及预后因素分析

Analysis of clinical features and prognostic characteristics of 34 patients with severe COVID-19

目的探讨34例重症新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者的临床特征,并分析影响其预后的因素。方法收集重症监护室34例重症COVID-19患者临床资料,其中治愈6例,死亡28例。分析其临床特征,采用多因素Cox回归分析影响其预后的因素。结果≤60岁、60<~70岁、>70岁重症COVID-19患者的死亡率分别为55.6%(5/9)、88.2%(15/17)、100%(8/8)。多因素Cox回归分析显示,年龄>60岁是年龄≤60岁死亡风险的3.509倍(P<0.001),T细胞亚群减少是无T细胞亚群减少死亡风险的2.753倍(P=0.001),D-二聚体升高是D-二聚体未升高死亡风险的2.405倍(P=0.003),PaO 2低水平是PaO 2高水平死亡风险的2.248倍(P=0.006),SaO 2低水平是SaO 2高水平死亡风险的1.600倍(P=0.021)。结论对于年龄>60岁、T细胞亚群减少、D-二聚体升高、PaO 2低水平、SaO 2低水平的重症COVID-19患者,临床需引起高度重视,严密观察病情以降低死亡率。

Objective To analysis of clinical characteristics and prognostic factors of 34 patients with severe corona virus disease 2019(COVID-19).Methods The clinical data of 34 severe patients with COVID-19 in ICU were collected.Among them,6 cases were cured and 28 cases died.The clinical characteristics were analyzed,and the prognostic factors were analyzed by Cox regression.Results The mortality rate of severe COVID-19 patients was 55.6%(5/9),88.2%(15/17)and 100%(8/8),respectively,when the patients were≤60 years old,60-70 years old and<70 years old.Cox regression analysis showed that the risk of death was 3.509 times(P<0.001)when the age was over 60,the risk of death was 2.753 times(P=0.001)when the T-cell subsets were reduced,the risk of death was 2.405 times(P=0.003)when the D-dimer was increased,the risk of death was 2.248 times(P=0.006)when the PaO 2 was low,the risk of death was 1.600 times(P=0.021)when the SaO 2 was low in severe COVID-19 patients.Conclusions Severe COVID-19 patients with age>60 years,reduced T-cell subsets,elevated D-dimer,low PaO 2 level,and low SaO 2 level should be strictly monitored to reduce mortality.