重型新型冠状病毒肺炎118例临床特征分析

Analysis of clinical characteristics of 118 patients with severe COVID-19

目的:研究重型2019冠状病毒病(coronavirus disease 2019,COVID-19)患者的相关临床预测指标。方法:选择2020年2月至3月期间武汉同济光谷院区重症监护室收治的51例重型COVID-19死亡患者(死亡组),另选择同期67例重型COVID-19未死亡出院患者(未死亡组),比较分析两组患者临床特征,影像学表现和实验室检查等差异。结果:两组患者年龄、吸烟史(>10年),合并慢性阻塞性肺疾病(COPD)、呼吸衰竭、心力衰竭、脓毒血症、肾功能衰竭、多器官功能障碍综合征、50%以上肺受累以及谷草转氨酶、尿素氮、乳酸脱氢酶、肾小球滤过率和N-末端B型利钠肽原等指标存在显著性差异(P<0.05)。多因素logistic回归分析发现仅年龄、吸烟史>10年、呼吸衰竭、多器官功能障碍综合征、尿素氮和肾小球滤过率与COVID-19患者预后相关(P<0.05)。结论:重型COVID-19患者年龄>67岁,合并吸烟史>10年或COPD,或者治疗过程中出现呼吸衰竭、多器官功能障碍综合征以及尿素氮和肾小球滤过率指标显著升高,往往预示病情加重,有死亡风险。

Objective:To analyse the relevant clinical predictors of patients who died of severe novel coronavirus disease 2019(COVID-19).Methods:Fifty-one patients who died of severe COVID-19(death group)admitted to the Intensive Care Unit of Wuhan Tongji Guanggu Hospital from February to March 2020,and 67 patients who did not die from severe COVID-19 at the same time(non-death group)were selected.Further,the clinical manifestations,imaging findings,and laboratory examinations of the two groups were compared and analyzed.Results:There were significant differences in age,smoking history(>10 years),chronic obstructive pulmonary disease(COPD),respiratory failure,heart failure,sepsis,renal failure,multiple organ dysfunction syndrome(MODS),more than 50%lung involvement,aspartate aminotransferase,urea nitrogen,lactate dehydrogenase,glomerular filtration rate(eGFR)and heart failure marker N-terminal pro-brain natriuretic peptide between the two groups(P<0.05).However,multivariate logistic regression analysis found that only age,smoking history(>10 years),respiratory failure,MODS,BUN and eGFR were correlated with the prognosis of COVID-19 patients(P<0.05).Conclusion:Severe COVID-19 patients who are older than 67 years old,with a history of smoking more than 10 years or COPD,or respiratory failure,MODS,and significantly elevated indicators of urea nitrogen and eGFR during treatment,which often indicates aggravation of the disease and risk of death.