新型冠状病毒肺炎患者继发感染的危险因素分析

Analysis of risk factors for subsequent infection in patients with COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)患者继发细菌感染的危险因素。方法回顾性分析天津市海河医院收治的136例COVID-19患者的临床资料,根据临床诊断结果分为继发细菌性肺炎(继发感染组,44例)和非继发感染组(92例)。比较2组患者临床特征、治疗、疾病转归等差异,Logistic回归分析患者继发感染的危险因素。结果继发感染组患者年龄、合并基础疾病比例高于非继发感染组(P<0.01),入院的氧合指数(OI)<400 mmHg、高热(体温>39℃)、重症、合并急性呼吸窘迫综合征(ARDS)、低蛋白血症、心功能不全比例也均高于非继发感染组,接受机械通气治疗、有创操作、激素治疗比例及住院时间均高于非继发感染组(P<0.05)。Logistics回归分析显示,合并基础疾病(OR=4.613,95%CI:1.756~12.118)、激素治疗(OR=2.403,95%CI:1.012~6.422)、入院OI<400 mmHg(OR=6.534,95%CI:2.064~20.691)、低蛋白血症(OR=12.949,95%CI:3.284~51.067)是继发细菌感染的独立危险因素。结论COVID-19继发感染与患者入院氧合指数低于400 mmHg、低蛋白血症、激素治疗、基础疾病关系密切,临床尽早干预可预防患者继发感染,有利于改善预后。

Objective To explore the risk factors of subsequent bacterial infection in patients with novel coronavirus disease 2019(COVID-19).Methods The clinical data of 136 patients with COVID-19 admitted to Tianjin Haihe Hospital were retrospectively analyzed.According to the results of clinical diagnosis,the patients were divided into two groups:subsequent infection group(44 cases)and non-subsequent infection group(92 cases).The clinical characteristics,treatment and disease outcome of the two groups were compared.The risk factors of subsequent infection were analyzed by Logistic regression.Results The results of univariate analysis showed that patient age and comorbidity were significantly higher in subsequent infection group than those of non-subsequent infection group(P<0.01).The proportion of OI<400 mmHg,hyperthermia(body temperature>39℃),severe cases,acute respiratory distress syndrome(ARDS),hypoproteinemia and cardiac insufficiency were also significantly higher in subsequent infection group than those in non-subsequent infection group(P<0.05).In the treatment,the proportion of mechanical ventilation,invasive operation,hormone treatment and hospitalization time were significantly higher in the subsequent infection group than those in the non-subsequent infection group(P<0.05).Logistic regression analysis showed that comorbidity(OR=4.613,95%CI:1.756-12.118),hormone therapy(OR=2.403,95%CI:1.012-6.422),admission OI<400 mmHg(OR=6.534,95%CI:2.064-20.691),hypoproteinemia(OR=12.949,95%CI:3.284-51.067)were independent risk factors for subsequent bacterial infection.Conclusion The subsequent infection of COVID-19 patients is closely related to OI<400 mmHg,hypoproteinemia,hormone therapy and comorbidity.Early clinical intervention can prevent subsequent infection in patients and help improve prognosis.