福州地区重症型新型冠状病毒肺炎危险因素的临床分析

Clinical analysis of risk factors for severe COVID-19 in Fuzhou

目的探索预测新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症型的危险因素,指导临床实践。方法回顾性分析福建医科大学教学医院福州肺科医院2020年1月至2020年4月收治的COVID-19患者90例的临床资料和入院24h内的相关实验室检查结果。根据《重症新型冠状病毒肺炎管理专家推荐意见》分为重症型(n=21)和轻症型(n=69)。利用SPSS19.0统计软件进行单因素分析和多因素二元Logistic回归分析检验重症型患者的危险因素;并将多因素分析结果中有统计学意义的危险因素绘制受试者工作曲线(receiver operator curves,ROC)。结果重症型患者年龄、一种及一种以上基础疾病、呼吸困难症状、心率、血尿素氮(blood urea nitrogen,BUN)、肌钙蛋白T(T cardiac troponin T,TnT)、中性粒细胞-淋巴细胞比率(neutrophil–lymphocyte ratio,NLR)、C反应蛋白(C-reactive protein,CRP)、血清降钙素原(procalcitonin,PCT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、谷草转氨酶(glutamicoxaloacetic transaminase,GOT)、胸腔积液发生率均高于轻症型(P值均<0.05);淋巴细胞计数(lymphocyte count,LY)、血红蛋白(haemoglobin,Hb)、血清白蛋白(albumin,ALB)、氧合指数(partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen,oxygenation index,用PaO_(2)/FiO_(2)表示)均低于轻症型。多因素Logistic回归分析结果显示年龄、呼吸困难症状、CRP、PaO_(2)/FiO_(2)是预测COVID-19重症型的独立危险因素(P值均<0.050),其OR值及95%可信区间(confidence interval,CI)分别为1.115(95%CI:1.037~1.199)、15.322(95%CI:1.606~146.140)、1.095(95%CI:1.033~1.162)、0.986(95%CI:0.976~0.995)。ROC曲线分析结果:年龄≥56岁、呼吸困难、CRP≥12.93mg/L、PaO_(2)/FiO_(2)≤326mmHg,以及4个变量联合检测预测COVID-19重症型的曲线下面积(area under the curve,AUC)分别为0.836(95%CI:0.749~0.924)、0.695(95%CI:0.551~0.838)、0.852(95%CI:0.769~0.936)、0.873(95%CI:0.754~0.991)、0.981(95%CI:0.959~1.000)。结论入院时高龄、呼吸困难、CRP值明显增高、低氧血症的COVID-19患者可能更易进展为重症型。

Objective To investigate the risk factors for severe stage of coronavirus disease 2019(COVID-19)and guide clinical practice.Methods A retrospective analysis was performed on the clinical data and laboratory examination results of 90 COVID-19 patients within 24 hours of admission from January 2020 to April 2020.According to Expert Recommendations for the Management of Severe Stage of COVID-19,the cases were divided into severe group(n=21)and mild group(n=69).Risk factors of severe patients were examined by univariate and multivariate logistic regression analysis using SPSS19.0 statistical software.Receiver operator curves(ROC)were used to assess the accuracy of variables.Results Age,underlying diseases,dyspnea,heart rate,blood urea nitrogen,T cardiac troponin T,neutrophil-lymphocyte ratio,C-reactive protein,procalcitonin,erythrocyte sedimentation rate,glutamic-oxaloacetic transaminase,and the incidence of pleural effusion in the severe group were higher than those in the mild group(all P<0.05).Lymphocyte count,haemoglobin,albumin and oxygenation index in the severe group were lower than those in the mild group(all P<0.05).Multivariate logistic regression analysis showed that age(OR 1.115;95%CI:1.037-1.199,P<0.05),dyspnea(OR 15.322;95%CI:1.606-146.140,P<0.05),C-reactive protein(OR 1.095;95%CI:1.033-1.162,P<0.05)and oxygenation index(OR 0.986;95%CI:0.976-0.995,P<0.05)were the independent risk factors for predicting severe COVID-19.The ROC analysis showed that the area under the curve(AUC)of age≥56 years,dyspnea,CRP≥12.93mg/L,oxygenation index≤326mmHg,and combination of four variables for predicting severe stage of COVID-19 and possible progression to severe stage of COVID-19 were 0.836(95%CI:0.749-0.924),0.695(95%CI:0.551-0.838),0.852(95%CI:0.769-0.936),0.873(95%CI:0.754-0.991),and 0.981(95%CI:0.959-1.000),respectively.Conclusion COVID-19 patients with advanced age,dyspnea,significantly elevated CRP,and hypoxemia at admission are more likely to develop severe disease.