炎症指标在非高龄新型冠状病毒感染肺炎患者预后价值的研究

Prognostic value of inflammatory makers for non-senior patients with coronavirus disease 19 pneumonia

目的:调查炎症指标在年龄<70岁的新型冠状病毒感染肺炎(COVID-19)患者的预后价值。方法:研究纳入2020年1月28日至2月28日,北京医疗队于武汉协和医院西院收治的89例年龄<70岁的COVID-19患者。根据临床表现、流行病学史、咽拭子核酸和影像学表现,所有患者均符合普通型、重型或危重型COVID-19确诊标准。通过阅读病例确定患者出院或者死亡时间。采用多因素COX模型分析患者住院期间死亡的危险因素。结果:本研究患者平均随访时间21 d,住院期间总共死亡13例,其中男性11例,女性2例。死亡组患者(n=13)入院时WBC、嗜中性粒细胞(NE)计数显著高于存活组患者(n=76),而淋巴细胞计数(LYM)则显著偏低。男性患者的病死率显著高于女性(23.4%vs.4.8%,χ^2=5.3,P=0.022)。WBC≥10×10^9/L或NE计数≥6×10^9/L的患者比WBC计数或者NE计数正常的患者病死率显著偏高(75.0%vs.10.7%,χ^2=17.3,P<0.001或31.6%vs.6.2%,χ^2=5.6,P=0.018)。LYM≤0.9×10^9/L比LYM正常的患者病死率高(26.3%vs.2.0%,χ^2=10.2,P=0.001)。矫正年龄、体质量后,WBC≥10×10^9/L和LYM≤0.9×10^9/L仍旧是死亡的危险因素(HR:8.6,95%CI:1.7~35.0,P=0.011;HR:5.8,95%CI:1.1~107.2,P=0.038)。据研究获得的有限资料,D-二聚体(n=65)、CRP(n=67)、降钙素原(n=21)高于中位数的患者病死率分别为20.0%、20.6%和45.5%,而低于以上中位数的患者无死亡病例。结论:炎症指标升高是70岁以下COVID-19患者死亡的危险因素。

Abjective:To elucidate the association of inflammatory markers with in-hospital death in relatively young patients with coronavirus disease-2019(COIVD-19) pneumonia. Methods: Retrospective study of patients(<70 years) diagnosed with COIVD-19 pneumonia and treated by Beijing Medical Team in West Hospital of Wuhan Union Hospital from January 28th to February 28th, 2020. All patients met the criteria of moderate, severe or critical cases as per their clinical symptoms, epidemic exposure, throat swab sample and imaging. Multivariable COX model was used to survey the independent risk factors of in-hospital death for this patients group. Results: Patients were followed up for an average of 21 days with 13 deceased cases reported, 11 male and 2 female. WBC count and neutrophils were significantly higher and lymphocytes were lower in deceased group than the survived group. Patients with WBC ≥10×109/L or neutrophils ≥ 6×109/L had more death cases documented than those with normal range of blood cells(75.0% vs. 10.7%, χ2=17.3, P<0.001 or 31.6% vs. 6.2%, χ2=5.6, P=0.018). Lymphocytopenia of ≤0.9×109/L also had higher risk of death than those with normal lymphocytes(26.3% vs. 2.0%, χ2=10.2, P=0.001). WBC ≥ 10×109/L and lymphocytes ≤ 0.9×109/L persisted to be independent risk predictors of death after adjusting for age and sex as confounding factors(HR: 8.6, 95% CI:1.7-35.0, P=0.011;HR: 5.8, 95%CI:1.1-107.2, P=0.038). Based on laboratory resources available, patients with D-dimer(n=65), C-reactive protein(n=67) and procalcitonin(n=21) higher than respective median values presented with fatality rates of 20.0%, 20.6% and 45.5%, while no deceased case was reported in patients with aforementioned values lower than median value. Conclusions: Elevation of inflammatory markers are independent predictors of death for relatively young patients(<70 years) with COVID-19 pneumonia.