重型危重型新型冠状病毒Delta变异株肺炎患者早期预警指标的回顾性分析

Retrospective analysis of early warning indicators for severe and critical patients with variant Delta of COVID-19

目的分析新型冠状病毒Delta变异株肺炎的重型、危重型患者疾病进展的早期指标及危险因素,为提高预后和疾病早期临床干预提供依据。方法回顾性分析106例新型冠状病毒Delta变异株肺炎患者的临床资料,按照诊断标准分为重型、危重型19例(重型危重型组)和轻型、普通型87例(轻型普通型组)。比较两组患者在一般资料、入院临床症状、基础疾病、实验室检查指标及影像学检查的差异,采用相关方法对以上指标进行统计分析。结果两组患者在年龄、乳酸脱氢酶、血浆D-二聚体、白细胞介素(IL)-6等多项实验室指标差异有统计学意义(P<0.05)。多元logistic回归分析显示:年龄、IL-6为重型、危重型新型冠状病毒肺炎的独立影响因素(P<0.05);IL-6最佳界值为9.89,敏感度为100%,特异度为92%。无进展重症时间为(5.16±2.43)d,影像高峰时间为(5.89±2.54)d,进展当天胸部CT肺内病损体积占比为(37.24±15.15)%,影像高峰期肺内病损体积占比(40.17±11.91)%。无进展重症时间生存分析结果显示血浆D-二聚体及IL-6有统计学意义(P<0.05)。结论乳酸脱氢酶、血浆D-二聚体及IL-6等多项实验室指标是重症危重症新型冠状病毒Delta变异株肺炎的早期预警指标。年龄和IL-6是重型、危重型新型冠状病毒Delta变异株肺炎的独立影响因素。IL-6可以作为重型、危重型新型冠状病毒Delta变异株肺炎的预警信号(临界值9.89 pg/mL)。肺内病损体积的量化指标亦是早期预测指标之一,而且血浆D-二聚体与IL-6更是影响进展速度的预测指标。

Objective To analyze the early indicators and risk factors of disease progression in patients with severe and critical COVID-19 of strain Delta, so as to provide a basis for improving prognosis and early clinical intervention of the disease. Methods Clinical data of 106 patients with COVID-19 Delta strain were retrospectively analyzed. The patients were divided into severe and critical group(19 cases), and mild and normal group(87 cases) according to the diagnostic criteria. The differences in general information, admission clinical symptoms, basic diseases, laboratory examination indexes and imaging examinations were compared between the two groups and analyzed. Results There were significant statistical differences in age, lactate dehydrogenase, plasma D-dimer, IL-6 and other laboratory indicators between the 2 groups(P<0.05). Multiple logistic regression analysis showed that age and IL-6 were independent risk factors for severe COVID-19(P<0.05). The optimal bound value of IL-6 was 9.89, with the sensitivity of 1.00, and the specificity of 0.92. The time of progression-free severe disease was(5.16±2.43) days, and the peak time of imaging was(5.89±2.54) days. The volume of lung lesions in chest CT on the day of progression was(37.24±15.15)%, and the volume of lung lesions in chest CT at the peak of imaging was(40.17±11.91)%. The time survival analysis of progression-free severe disease showed that plasma D-dimer and IL-6 had statistical significance(P<0.05). Conclusions Laboratory indicators such as lactate dehydrogenase, plasma D-dimer and IL-6 are the early warning indicators of COVID-19 strain Delta. Age and IL-6 are independent risk factors for severe and critical COVID-19. IL-6 can be used as an early warning signal for severe and critical COVID-19(critical value 9.89 pg/mL). The quantitative index of lung lesion volume is also one of the early predictors, and the plasma D-dimer and IL-6 are the predictors that affect the progression.