福建省COVID-19患者重症危险因素病例对照研究

Case-control study on severe risk factors in COVID-19 patients in Fujian Province

目的分析福建省COVID-19患者的流行病学特征和实验室检查等指标,探讨其进展为重症的危险因素。方法收集福建省2020年1月22日-3月7日已出现临床最终结局(含痊愈出院、死亡等)的COVID-19确诊病例231例,运用单因素和多因素Logistic回归分析模型分析重症化的危险因素。结果2020年1月22日-3月7日出院的231例COVID-19患者中,重症和危重症患者占16.88%(39/231)。单因素分析显示,重症组患者多合并有基础疾病(71.80%),高于非重症组(34.40%)(χ^(2)=18.808,P<0.001);其中患高血压、心血管疾病、肺部疾病、其他慢性病等因素在两组间差异均有统计学意义(均有P<0.05)。两组间多项血液学检测指标差异均有统计学意义(均有P<0.05)。多因素Logistic回归分析模型分析显示:年龄≥65岁(OR=17.067,95%CI:2.640~110.327)、淋巴细胞偏低(OR=4.731,95%CI:1.175~19.046)、肝功能异常(OR=12.458,95%CI:2.559~60.649)、降钙素偏高(OR=3.577,95%CI:1.733~7.384)和C反应蛋白偏高(OR=2.354,95%CI:1.012~5.478)是COVID-19患者进展为重症的危险因素。得到的回归方程对训练样本拟合优度良好(AUC=0.941)。结论淋巴细胞偏低、肝功能异常、降钙素偏高、C反应蛋白偏高可作为重症COVID-19患者的早期预警指标。对于年龄≥65岁老年患者以及有上述实验室检查指标异常的患者应多加关注并及时采取有效的治疗措施。

Objective To analyze the epidemiological characteristics and laboratory tests of coronavirus diseases 2019(COVID-19)cases in Fujian province and to explore the risk factors for their progression to severe cases.Methods The clinical and epidemiological data of COVID-19 confirmed patients with clinical final outcome(including recovery death,etc.)from January 22 to March 7 in 2020 in Fujian were collected.The risk factors of the severe cases were analyzed by univariate and multivariate Logistic regression.Results Up to March 7,2020,a total of 231 patients were collected in Fujian province,among which,39(16.88%)were severe and critical cases.The univariate analysis showed that most patients in the severe group had underlying diseases(71.80%),which was significantly higher than that in the non-severe group(34.40%)(χ^(2)=18.808,P<0.001).Among them,hypertension,cardiovascular disease,lung disease,other chronic diseases and other factors were statistically different between the two groups(all P<0.05).Then,numbers of hematological tests were statistical differences between the two groups.Multivariate Logistic regression analysis revealed that age≥65 years old(OR=17.067,95%CI:2.640-110.327),low level of lymphocyte(OR=4.731,95%CI:1.175-19.046),liver dysfunction(OR=12.458,95%CI:2.559-60.649),high level of calcitonin(OR=3.577,95%CI:1.733-7.384)and high level of C-reaction protein(OR=2.354,95%CI:1.012-5.478)were risk factors for the progression of COVID-19 patients to severe illness.The obtained regression equation fits the training sample well(AUC=0.941).Conclusions Low level of lymphocyte,liver dysfunction,high level of calcitonin and high level of C-reaction protein could be used as the early warning indicators for severe cases.More attention should be paid to elderly patients age≥65 years old and patients with the above laboratory test abnormality and timely and effective treatment should be taken.