新型冠状病毒肺炎重症化的高危因素分析

High risk factors associated with severity of COVID-19 patients

目的探讨新型冠状病毒肺炎(COVID-19)重症化的高危因素,为精准诊疗提供依据。方法回顾性分析2020年1月20日-2月13日于安徽阜阳市第二人民医院住院的COVID-19患者的临床资料,按照病情进展与否分为稳定组和重症化组,使用多因素COX比例风险回归分析及动态变化评估重症化的高危因素。结果最终纳入143例COVID-19确诊患者,年龄43.5(32.7,52.4)岁,其中81例(56.6%)为男性,28例(19.6%)存在基础疾病。最常见的症状为发热[119例(83.2%)],其次为干咳[(77例(53.8%)]。共有122例(85.3%)病情持续好转(稳定组),21例(14.7%)在出现症状2周内病情加重(重症化组)。多因素COX比例风险回归分析显示,年龄>60岁(HR=3.5,95%CI 1.4~9.0)、合并基础疾病(HR=3.9,95%CI 1.5~10.4)、乳酸脱氢酶>250.0 U/L(HR=4.1,95%CI 1.4~12.6)、淋巴细胞绝对值<1.0×109/L(HR=6.8,95%CI 2.3~20.7)为COVID-19患者重症化的高危因素。结论在COVID-19救治过程中明确其重症化高危因素有利于制定个体化、精准化的治疗方案。

Objective To explore the high risk factors associated with severity of coronavirus disease-2019(COVID-19)to provide a basis for precise diagnosis and treatment.Methods The clinical data of COVID-19 patients admitted to Fuyang Second People's Hospital in Anhui Province from Jan.20,2020 to Feb.13,2020 were retrospectively analyzed.According to the progress of the disease or not,the patients were divided into stable group and severe group.Multivariate COX proportional hazards regression analysis and dynamic changes were used to assess the high-risk factors for exacerbation of the disease.Results Finally 143 confirmed patients with COVID-19 were enrolled,the average age was 43.5(32.7,52.4)years,81(56.6%)cases were male,28(19.6%)cases had at least one comorbidity(underlying disease).The most common symptom was fever(119,83.2%),followed by dry cough(77,53.8%).Totally,122 patients(85.3%)had continued improvement(stable group),and 21(14.7%)deteriorated within 2 weeks of symptoms onset(severe group).Multivariate COX proportional hazards regression analysis showed that age over 60 years(HR=3.5,95%CI 1.4-9.0),combined with underlying diseases(HR=3.9,95%CI 1.5-10.4),LDH>250.0 U/L(HR=4.1,95%CI 1.4-12.6),and absolute lymphocyte count less than 1.0×109/L(HR=6.8,95%CI 2.3-20.7)were high risk factors for COVID-19 patient deterioration.Conclusions Identification of high-risk factors for deterioration of COVID-19 can assist early detection of cases with severe tendency and develop individualized and precise treatment strategy,which might alleviate the shortage of medical resources and reduce mortality.