重型及危重型新型冠状病毒肺炎的早期临床预警指标分析

Analysis of early clinical warning indicators for severe and critical corona virus disease 2019

目的分析新型冠状病毒肺炎(COVID-19)重型及危重型患者临床特征,筛选进展为重症及危重型COVID-19的早期预警指标,为早期识别及救治提供临床参考。方法收集2020年2月13日至3月15日援武汉期间,武汉市某医院重症病区收治的178例COVID-19患者的临床资料。回顾性分析患者的人口学特征、临床表现、实验室检查、影像学检查、并发症及治疗方案等。根据诊疗指南分为重症(重型及危重型)组与非重症组,采用logistic回归分析,筛选进展为重型及危重型COVID-19的危险因素。结果年龄大于70岁(P<0.001,OR=0.76,95%CI:0.29~5.21),白细胞计数(WBC)>10×10^(9)/L(P=0.004,OR=1.02,95%CI:0.61~2.29),C反应蛋白(CRP)>150 mg/L(P=0.005,OR=0.21,95%CI:0.12~0.49),乳酸脱氢酶(LDH)>400 U/L(P<0.001,OR=1.56,95%CI:0.43~3.23)及肺炎症指数(PI)>75%(P<0.001,OR=2.32,95%CI:1.91~3.54)是COVID-19患者重型及危重型的早期独立危险指标。结论重型及危重型COVID-19早期症状不典型,病情易进展,需密切观察病情变化,尤其是高龄患者,WBC>10×10^(9)/L,CRP>150 mg/L与LDH>400 U/L及PI>75%可作为COVID-19重症及危重化倾向的早期预警指标。

Objective To analyze the clinical characteristics of severe and critically patients with novel coronavirus pneumonia(COVID-19),screen the early predicting indicators that progress to severe and critically COVID-19,and thus providing clinical reference for early identification and treatment.Methods The clinical data of 178 patients with COVID-19 admitted to the intensive care unit of a hospital in Wuhan from February 13,2020 to March 15,2020 were collected.Demographic characteristics,clinical manifestations,laboratory-related indicators,imaging examination,complications and treatment programs of the patients were retrospectively analyzed.Patients were divided into the severe group(severe/critical type)and no-severe group according to the National Health and Health Commission of the People′s Republic of China.The logistic regression analysis was used to screen the risk factors of patients of severe/critical type.Results Age over 70 years(P<0.001,OR=0.76,95%CI:0.29 to 5.21),white blood cell(WBC)count>10×10^(9)/L(P=0.004,OR=1.02,95%CI:0.61-2.29),C-reactive protein(CRP)levels>150 mg/L(P=0.005,R=0.21,95%CI:0.12-0.49),lactate dehydrogenase(LDH)levels>400 U/L(P<0.001,OR=1.56,95%CI:0.43-2.23),and pulmonary inflammation(PI)index>75%(P<0.001,OR=2.32,95%CI:1.91-3.54)were early independent risk indicators for severe and critical COVID-19 patients.Conclusion Early symptoms of severe/critical type COVID-19 pneumonia are not typical and the disease is prone to progression,requiring close observation,especially for elderly patients.WBC>10×10^(9)/L,CRP>150 mg/L,LDH>400 U/L and PI>75%can be used as early predictors of severe and critical disease tendency.