高龄新型冠状病毒肺炎患者肝肾及凝血功能损伤的临床特征分析

Clinical characteristics of liver,kidney and coagulation injury in elderly patients with novel coronavirus pneumonia(COVID-19)

【目的】了解新型冠状病毒肺炎(COVID-19)患者的临床特点,重点分析高龄COVID-19患者肝肾及凝血功能损伤以及临床转归情况。【方法】收集2020年1月20日至2020年4月20日上海市公共卫生临床中心收治的72例COVID-19患者的临床资料,包括人口学数据、临床症状、实验室检测结果、合并的基础疾病、出院及死亡情况,根据病情轻重及年龄分层进行回顾性分析。【结果】72例COVID-19患者中,重症患者27例,非重症患者45例;高龄(≥60岁)患者31例,低龄(<60岁)患者41例;发热(83.3%)、咳嗽(36.1%)、疲劳(23.6%)是最常见的临床症状。患者的中位年龄为56.1岁(15~80岁),非重症和重症患者的平均年龄分别为47.4岁和64.6岁。高龄组和低龄组中重症患者分别占67.7%(21/31)和14.6%(6/41)。与低龄患者比较,高龄患者的天冬氨酸转氨酶、肌酐及D-二聚体、纤维蛋白原降解产物(FDP)水平显著增高(P<0.05),住院时间显著延长(P<0.001),死亡比例显著增加(P<0.05)。【结论】高龄COVID-19患者存在明显的肝肾及凝血功能损伤,影响COVID-19的临床预后。

[Objective]To evaluate the clinical features and clinical outcome of liver,kidney and coagulation injury in patients with novel coronavirus pneumonia(COVID-19),especially in those elderly COVID-19 patients.[Methods]Clinical data of 72 COVID-19 patients admitted to the Shanghai Public Health Clinical Center from January 20,2020 to April 20,2020 was collected,including demographic data,clinical symptoms,laboratory testing results,underlying comorbidities,discharge and death,and then conducted the analysis stratified by clinical severity and age.[Results]Of the 72 COVID-19 patients,27 were critically ill and 45 were mild.There were 31 elderly patients(≥60 years old)and 41 young patients(<60 years old).Fever(83.3%),cough(36.1%)and fatigue(23.6%)were the most common clinical symptoms.The median age of the patients was 56.1 years(15-80 years);the mean age of mild and critically ill patients were 47.4 years and 64.6 years,respectively.The proportion of critically ill cases in the elderly group and the young group was 67.7%(21/31)and 14.6%(6/41),respectively.Organ injury in elderly patients included significantly increased aspartate aminotransferase,creatinine D-dimer,and FDP)(P<0.05).Of the patients,the length of hospital stay of the elderly patients was significantly longer(P<0.001),and the mortality increased significantly(P<0.05).[Conclusion]Elderly COVID-19 patients have severe liver,kidney and coagulation injury,which may induce longer duration of hospital stay and increased mortality.Therefore,elderly COVID-19 patients may have worse clinical outcome.