新型冠状病毒肺炎患者死亡相关风险因素的文献回顾性分析

Retrospective Review of the Literature on Risk Factors Associated with Mortality in COVID-19 Patients

目的调查分析新型冠状病毒肺炎(COVID-19)患者死亡相关风险因素及影响程度,为临床制定治疗方案提供参考。方法检索PubMed/Medline、OVID、Web of Science、中国知网(CNKI)、万方医学网及维普中文期刊(VIP)等数据库中有关COVID-19死亡患者的临床病例对照研究或回顾性病例分析,时间为2019年12月—2020年9月;对患者一般社会人口学特征、合并基础疾病、并发症或死亡原因等因素进行计量统计学分析。结果获13篇文献,质量推荐等级A级8篇,B级4篇,C级1篇;涉及三大洲COVID-19死亡患者,共1377例,包括32种死亡相关风险因素评估项,其构成分布显示,在一般社会人口学特征方面:离退休、老年人(>65岁)、男性、有饮酒史死亡率占比较高,为高死亡风险因素;患者基础疾病方面:高血压(36.48%)、糖尿病(22.21%)、冠心病(19.71%)为风险占比较高的前3名;在并发症或死亡原因方面:呼吸衰竭(61.90%)、多器官功能衰竭(53.33%)、心力衰竭(51.06%)为占比较高的死亡原因。结论COVID-19中患有慢性代谢性疾病,且有长期饮酒史的老年男性为死亡高危人群,以急性呼吸衰竭、多器官功能衰竭或心力衰竭而死亡较为多发、高发,临床治疗时宜对该类人群进行重点监护和谨慎用药。

OBJECTIVE To investigate and analyze the risk factors associated with mortality in patients with COVID-19 and the extent of their impact,so as to provide reference for clinical treatment planning.METHODS Clinical case-control studies or retrospective case analysis of COVID-19 deaths in databases such as PubMed/Medline,OVID,Web of Science,CNKI,Wanfang and VIP were searched from December 2019 to September 2020.And the patients’general social and demographic characteristics,complicated underlying diseases,causes of death or complications and other factors were analyzed by quantitative statistics.RESULTS Obtained 13 papers,8 papers of recommendation level A,4 papers of recommendation level B and 1 paper of recommendation level C.There were 1377 COVID-19 dead patients recorded on three continents,including 32 related risk factors.Death risk distribution showed that,in terms of general social demographic characteristics,retirement,the elderly(aged>65 years old),male,with a history of drinking accounted for a relatively high proportion of death,which were high risk factors for death.In terms of patients’basic diseases,hypertension(36.48%),diabetes(22.21%)and coronary heart disease(19.71%)were the top three with high risk.In the assessment of death from complications or causes of death,respiratory failure(61.90%),multi-organ failure(53.33%),and heart failure(51.06%)were the most common causes of death.CONCLUSION Elderly patients with chronic metabolic diseases and a long history of alcohol consumption in COVID-19 are at high risk of death,and deaths due to acute respiratory failure,multi-organ failure or heart failure are more frequent and more frequent.Therefore,intensive care and prudent medication should be given to these groups when appropriate for clinical treatment.