武汉地区107例重症新型冠状病毒肺炎患者的预后危险因素分析

Risk factors for fatal outcome in patients with severe COVID-19:an analysis of 107 cases in Wuhan

目的分析影响重症新型冠状病毒肺炎(COVID-19)患者死亡的危险因素。方法回顾性分析2020年2月12日至3月12日在武汉大学人民医院住院治疗的107例重症COVID-19患者的临床特征,根据患者预后将其分为存活组(n=58)和死亡组(n=49),先对两组患者的基线临床特征、实验室检查结果进行单因素分析。为了排除混杂因素,应用随机森林模型筛选出变量重要性排序,再纳入二分类Logistic回归模型,分析患者死亡的独立危险因素。结果单因素分析显示,两组在年龄、临床分型、干咳、呼吸困难及实验室检查指标方面比较,差异均具有统计学意义(P<0.05或<0.01)。应用随机森林模型对单因素分析有统计学意义的变量筛选进行重要性排序,将筛选的变量纳入二分类Logistic回归模型,经逐步回归分析,患者临床分型、年龄、中性粒细胞计数和CD3+T淋巴细胞比例是重症COVID-19患者死亡的独立危险因素。干咳是重症COVID-19患者死亡的独立保护因素。结论COVID-19死亡患者更多出现免疫功能受抑制、继发感染和炎性因子风暴,这些因素可能共同作用于重症患者,最终出现顽固性的低氧血症和多器官功能障碍而导致患者死亡,密切监测上述指标并及时干预可能是挽救重症COVID-19患者生命的有效策略。

Objective To analyze the risk factors of fatal outcome in patients with severe COVID-19.Methods The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12,2020 were retrospectively analyzed.During the hospitalization 49 patients died(fatal group)and 58 patients survived(survival group).The clinical characteristics,baseline laboratory findings were analyzed using R and Python statistical software.The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression.Results Univariate analysis showed that the two groups had statistically significant differences in age,clinical classification,dry cough,dyspnea and laboratory test indicators(P<0.05 or<0.01).The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis,and the selected variables were included in the binary logistic regression model.After stepwise regression analysis,the patient’s clinical type,age,neutrophil count,and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients.Dry cough is an independent protective factor for the death of severe COVID-19 patients.Conclusion COVID-19 patients with fatal outcome are more likely to have suppressed immune function,secondary infection and inflammatory factor storm.These factors may work together in severe patients,leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients.The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.