COVID-19轻症转重症的危险因素及年龄校正Charlson合并症指数对其的预测价值

Risk factors of progression from mild to severe COVID-19 and the predictive value of age-adjusted Charlson complication index

目的分析COVID-19轻症转重症的危险因素,并探讨年龄校正Charlson合并症指数(aCCI)对其的预测价值。方法回顾性分析2020年1月—3月天津市海河医院收治的133例成人COVID-19确诊患者的临床资料,根据病情变化选择轻症(轻型及普通型)未转重症(重型、危重型)者73例及轻症转重症者22例作为研究对象。通过查阅电子病历,收集患者的一般临床资料(性别、年龄、Charlson合并症、原发性高血压、糖尿病、冠心病、吸烟史)及白细胞(WBC)、中性粒细胞(N)、淋巴细胞(L)、中性粒细胞淋巴细胞比值(NLR)、D-二聚体、血清钠(Na)、白蛋白、C反应蛋白(CRP)及白细胞介素6(IL-6)等实验室检查指标,Charlson合并症评分与年龄积分相加即为aCCI。比较轻症转重症与未转重症COVID-19患者的临床资料,将P<0.2的指标行多因素COX回归分析确定COVID-19轻症转重症的独立危险因素,绘制受试者工作特征(ROC)曲线分析aCCI预测COVID-19轻症转重症的价值。结果轻症转重症患者年龄高于未转重症者,Charlson合并症、原发性高血压、糖尿病及冠心病比例及aCCI均高于未转重症者(P均<0.05),有吸烟史比例两者比较无统计学差异。轻症转重症患者L、Na及白蛋白水平均低于未转重症者,NLR、CRP及IL-6水平均高于未转重症者(P均<0.05),WBC、N及D-二聚体水平两者比较无统计学差异。多因素COX回归分析显示,L<0.8×10^9/L、IL-6>10 pg/mL、aCCI≥3分为COVID-19患者轻症转重症的独立危险因素(P均<0.05)。ROC曲线分析结果显示,aCCI预测COVID-19患者轻症转重症的AUC为0.847,最佳阈值为2.5分时的特异度为0.890、敏感度为0.682。结论aCCI≥3分、L<0.8×10^9/L、IL-6>10 pg/mL为COVID-19患者由轻症转为重症的独立危险因素;aCCI对预测COVID-19患者轻症转重症具有一定价值,可作为快速预测COVID-19患者病情变化并早期干预的指标。

Objective To analyze the risk factors of progression from mild to severe COVID-19,and to explore the predictive value of age-corrected Charlson complication index(aCCI).Methods The clinical data of 133 adult patients with COVID-19 who were admitted to Tianjin Haihe Hospital from January 2020 to March 2020 were analyzed retrospectively.According to the changes of the disease,73 mild patients(mild type and common type) who did not turn into severe cases(severe and critical type) and 22 patients from mild to severe were selected as the subjects of the study.By consulting electronic medical records,the general clinical data(sex,age,Charlson complication,primary hypertension,diabetes,coronary heart disease,and smoking history) and laboratory indexes such as leukocyte(WBC),neutrophil(N),lymphocyte(L),neutrophil lymphocyte ratio(NLR),D-dimer,serum sodium(Na),albumin,C-reactive protein(CRP) and interleukin-6(IL-6) were collected.The aCCI was the sum of patient’s Charlson complication score and age score.We compared the clinical data between the patients with progression from mild to severe COVID-19 and the mild patients who did not turn into severe cases.Multivariate COX regression was used to analyze the independent risk factors for progression from mild to severe COVID-19,and the receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of aCCI in the progression of COVID-19.Results The age of patients with progression from mild to severe COVID-19 was older than the mild patients who did not turn into severe cases,and the proportions of Charlson complication,primary hypertension,diabetes and coronary heart disease and aCCI score were higher(all P<0.05);there was no significant difference in smoking history between them.The levels of L,Na and albumin were lower,while the levels of NLR,CRP and IL-6 were higher in the mild to severe patients than those in mild patients who did not change to severe cases(all P<0.05);there were no significant differences in the levels of WBC,N or D-dimer between them.Multivariate COX regression analysis showed that L<0.8×10^9/L,IL-6>10 pg/mL and aCCI≥3 were independent risk factors for patients with progression from mild to severe COVID-19.The results of ROC curve showed that the AUC,specificity,sensitivity and optimal threshold of aCCI in predicting the progression from mild to severe COVID-19 were 0.847,0.890,0.682 and 2.5.Conclusion ACCI≥ 3,L<0.8×10^9/L and IL-6>10 pg/mL are independent risk factors for patients with progression from mild to severe COVID-19;aCCI has a certain predictive value for this,and can be used as a rapid predictor of disease changes and early intervention for COVID-19 patients.