重型/危重型新型冠状病毒肺炎患者临床特征及死亡危险因素分析

Clinical Characteristics and Predictors Risk Factors in Hospitalized Severe/Critical COVID-19 Patients

目的:分析重型/危重型新型冠状病毒肺炎(COVID-19)患者的临床特征及死亡相关危险因素。方法:对2020-02-06—2020-03-09于武汉大学人民医院收治的149例重型/危重型COVID-19患者的临床资料及实验室结果进行回顾性分析。采用多因素COX回归分析影响重型/危重型COVID-19患者预后相关因素,绘制受试者工作特征曲线(ROC)评估各危险因素对死亡的预测价值。结果:共计149例患者纳入本研究,其中存活组103例,死亡组46例。两组在年龄、既往史、主要症状上差异无统计学意义(P>0.05)。多因素回归分析提示:高水平的血钾(HR=1.55,95%CI 1.17-2.06,P<0.01)、高尿素氮血症(HR=1.10,95%CI 1.06-1.15,P<0.01)、高乳酸血症(HR=1.14,95%CI 1.01-1.32,P<0.05)是重型/危重型COVID-19患者死亡的独立危险因素,而高水平的淋巴细胞计数(HR=0.84,95%CI 0.71-0.99,P<0.05)、动脉血氧分压(HR=0.97,95%CI 0.95-0.99,P<0.05)是重型/危重型COVID-19患者死亡的独立保护因素。血钾、尿素氮、乳酸、淋巴细胞计数、动脉血氧分压均对重型/危重型COVID-19患者死亡风险具有较高的预测价值。结论:重型/危重型COVID-19患者死亡率较高,低氧血症、低淋巴细胞计数、高乳酸血症、血钾升高以及高尿素氮血症是住院患者死亡的独立危险因素。

Objective:To analyze the characteristics and risk factors of hospitalized severe/critical COVID-19 patients.Method:The clinical characteristics and related laboratory results of 149 patients with severe/critical COVID-19 from February 6th,2020 to Marth 9th,2020 were retrospectively analyzed.Multivariate COX regression analysis was Used to analyze the prognostic factors of patients with servere/critical COVID-19,the receiver operating curve(ROC)was wsed to evaluate the predictive value of each risk factor.Results:A total of 149 patients were included in the study,including 103 patients in survival group and 46 patients in non-survival group.There were no statistically significant differences in age,previous history or major symptoms between the two groups(P>0.05).Multivariate regression analysis suggested that potassium,urea and lactic acid might be independent risk factors(HR=1.55,95%CI 1.17-2.06,P<0.01;HR=1.10,95%CI 1.06-1.15,P<0.01;HR=1.14,95%CI 1.01-1.32,P<0.05),high lymphocyte count and arterial oxygen pressure may be the independent protective factors(HR=0.84,95%CI 0.71-0.99,P<0.05;HR=0.97,95%CI 0.95-0.99,P<0.05).Conclusion:Hypoxemia,low lymphocyte count hyperlactic acid,abnormal blood potassium and renal impairment are important risk factors which would increase the mortality rate in severe/critical COVID-19 patients.