老年重症及危重症新型冠状病毒感染患者预后的危险因素分析

Risk factors of prognosis in severe or critically ill elderly patients infected with 2019 novel coronavirus

目的探讨影响老年重症及危重症新型冠状病毒感染患者预后的危险因素。方法选择2020年1月至3月武汉某定点医院某病区收治的61例新型冠状病毒感染老年确诊患者为研究对象,回顾性分析患者的临床资料。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验进行组间比较。采用Cox回归模型进行患者的生存分析。结果老年重症及危重症新型冠状病毒感染患者病死率为55.7%(34/61)。死亡病例具有以下特征:高龄,女性,发病时间长,合并呼吸困难症状比例高,天门冬氨酸氨基转移酶、碱性磷酸酶、乳酸脱氢酶、尿素氮、肌酐、肌酸激酶同工酶、C反应蛋白、中性粒细胞计数水平高,白蛋白、钙离子和淋巴细胞计数水平低。影响老年重症及危重症患者预后的独立危险因素是肌酸激酶同工酶(P=0.000,HR=1.065,95%CI 1.034~1.096),白蛋白(P=0.001,HR=0.867,95%CI 0.797~0.943),钙离子(P=0.000,HR=0.089,95%CI 0.028~0.279)和呼吸困难(P=0.004,HR=6.538,95%CI 1.840~23.237)。结论影响老年重症及危重症新型冠状病毒感染患者预后的独立危险因素为高肌酸激酶同工酶、低白蛋白、低血钙及存在呼吸困难症状。

Objective To explore the risk factors affecting the prognosis of elderly severe or critically ill patients infected with 2019 novel coronavirus.Methods A total of 61 old patients(over 60 years old)infected with 2019 novel coronavirus who were admitted to a ward of a designated hospital in Wuhan from January to March 2020 were selected as the research subjects,and their clinical data were collected and retrospectively analyzed.SPSS statistics 22.0 was used for data analysis.According to data types,student′s t test,rank sum test or Chi-square test was used for intergroup comparison.Cox regression model was used to analyze the survival of patients.Results The elderly patients with severe and critical illness had a mortality rate of 55.7%(34/61).The death group showed the following features:very old,female,longer time of onset,high proportion of dyspnea,higher levels of aspartate transaminase,alkaline phosphatase,lactate dehydrogenase,urea nitrogen,creatinine,creatine kinase isoenzyme,C-reactive protein and neutrophilic granulocyte count,and low levels of albumin,calcium and lymphocyte count.The independent risk factors influencing the prognosis of elderly patients with severe and critical diseases were creatine kinase isoenzyme(P=0.000,HR=1.065,95%CI 1.034-1.096),albumin(P=0.001,HR=0.867,95%CI 0.797-0.943),calcium(P=0.000,HR=0.089,95%CI 0.028-0.279),and dyspnea(P=0.004,HR=6.538,95%CI 1.840-23.237).Conclusion High creatine kinase isoenzyme,low albumin,low blood calcium,and dyspnea are independent risk factors for elderly severe and critically ill patients infected with 2019 novel coronavirus.