重症新型冠状病毒肺炎患者的临床特点及预后相关危险因素分析

Clinical characteristics and risk factors affecting outcomes of the patients with severe coronavirus disease 2019

目的分析重症新型冠状病毒肺炎(COVID-19)患者的临床特点及预后相关危险因素。方法回顾性分析2020年2-4月曾入住武汉火神山医院ICU的重症COVID-19患者的临床资料。根据转归情况分为存活组与死亡组,比较两组患者的一般人口学资料、临床表现、实验室检查、治疗方式等,分析影响患者预后的危险因素。结果共纳入122例重症COVID-19患者,死亡56例,病死率为45.9%。死亡组合并冠心病的比例高于存活组[19.6%(11/56)vs.7.6%(5/66),P=0.049],入院时血小板计数低于存活组[190.1(132.3,245.0)×10^(9)/L vs.217.0(176.0,262.3)×10^(9)/L,P=0.015],C反应蛋白、脑钠肽水平高于存活组[37.4(4.3,125.6)mg/L vs.8.9(2.7,51.4)mg/L,P=0.027;65.17(18.84,167.71)pg/ml vs.16.60(0.01,67.68)pg/ml,P=0.007],凝血酶原时间和凝血酶时间长于存活组[14.20(13.22,15.86)s vs.13.27(12.16,14.27)s,P<0.001;16.32(15.11,18.02)s vs.15.75(14.81,16.62)s,P=0.037]。动态观察显示,两组中性粒细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值以及乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)水平差异有统计学意义(P<0.05)。ROC曲线分析结果显示,LDH、α-HBDH预测COVID-19患者死亡结局的价值较高,曲线下面积(AUC)>0.7。结论对于高龄及有基础疾病的重症COVID-19患者,应密切关注其血常规、LDH和α-HBDH变化,早期识别出高死亡风险的患者,及早采取有效措施进行干预,以改善预后。

Objective To investigate the clinical characteristics of severe coronavirus disease 2019(COVID-19)and explore the relevant risk factors that affect outcomes of the patients.Methods A retrospective analysis was performed on the data of the patients with severe COVID-19 admitted to the ICU of Huoshenshan Hospital of Wuhan City during the period from February to April,2019.The patients were classified into survival group and death group.The general data,clinical manifestations,laboratory examinations,and treatments were compared between the 2 groups.Results A total of 122 severe COVID-19 patients were included in the study,56 died and the fatality rate was 45.9%.The proportion of comorbidities of coronary heart disease in death group was significantly higher than that in the survival group[19.6%(11/56)vs.7.6%(5/66),P=0.049].Compared with patients in the survival group,the platelet count in the death group decreased[190.1(132.3,245.0)×10^(9)/L vs.217.0(176.0,262.3)×10^(9)/L,P=0.015]and the levels of C-reactive protein and brain natriuretic peptide in the death group increased[37.4(4.3,125.6)mg/L vs.8.9(2.7,51.4)mg/L,P=0.027 and 65.17(18.84,167.71)pg/ml vs.16.60(0.01,67.68)pg/ml,P=0.007].The prothrombin time and thrombin time in the death group were longer than those in the survival group[14.20(13.22,15.86)s vs.13.27(12.16,14.27)s,P<0.01 and 16.32(15.11,18.02)s vs.15.75(14.81,16.62)s,P=0.037].Dynamic observation data showed that there were significant differences in neutrophil count,lymphocyte count,neutrophil/lymphocyte ratio and levels of both lactate dehydrogenase andα-hydroxybutyrate dehydrogenase(α-HBDH)between the two groups.ROC curve analysis showed that LDH andα-HBDH were of high value in predicting outcome,and the area under the curve was more than 0.7.Conclusions We should pay close attention to the changes of blood routine,LDH,andα-HBDH for older patients with underlying diseases.This will help us to identify the patients with high risk of death in the early stage,and take effective treatment measures as early as possible to improve the prognosis.