维持性血液透析患者新型冠状病毒感染重症的相关危险因素

Risk factors associated with severe coronavirus disease 2019 in maintenance hemodialysis patients

目的 分析维持性血液透析患者新型冠状病毒感染(COVID-19)重症的危险因素,为患者的早期风险识别提供参考。方法 回顾性收集2022年3月至4月吉林省人民医院收治的73例确诊COVID-19的维持性血液透析患者的临床资料,根据患者临床分型分为MC组(轻型及普通型,61例)与SC组(重型及危重型,12例),收集患者基线资料[年龄、性别、COVID-19疫苗接种情况、年龄校正Charlson合并症指数(aCCI)、原发性高血压、糖尿病、冠心病、恶性肿瘤、透析时间]、首发临床症状(发热、干咳、乏力、咽痛、腹泻、呼吸困难)、入院24 h内实验室检查指标(白细胞总数、中性粒细胞总数、淋巴细胞总数、C反应蛋白、降钙素原、D-二聚体、白蛋白),采用多因素logistic回归分析维持性血液透析患者COVID-19重症的危险因素。结果 两组年龄、aCCI、淋巴细胞总数、C反应蛋白及D-二聚体差异有统计学意义(P<0.01);多因素logistic回归分析显示,年龄大及C反应蛋白水平高为维持性血液透析患者COVID-19重症的独立危险因素(OR=1.256, 95%CI:1.016~1.553,P=0.035;OR=1.021,95%CI:1.001~1.041,P=0.041)。结论 维持性血液透析患者COVID-19疫苗接种率低,整体年龄偏大。年龄大及C反应蛋白水平高为维持性血液透析患者COVID-19重症的独立危险因素。

Objective To analyze the risk factors of severe coronavirus disease 2019(COVID-19)in maintenance hemodialysis patients,and provide reference for early risk identification of the patients.Methods The clinical data of 73 maintenance hemodialysis patients diagnosed with COVID-19 admitted to Jilin Province People s Hospital from March to April 2022 were restrospectinely collected,and the patients were divided into MC group(mild and ordinary type,n=61)and SC group(severe and critically severe type,n=12)based on clinical classification.The patients baseline data[age,gender,COVID-19 vaccination status,age adjusted Charlson s complication index(aCCI),primary hypertension,diabetes,coronary heart disease,malignant tumor,dialysis time],first clinical symptoms(fever,dry cough,fatigue,sore throat,diarrhea,dyspnea)and laboratory examination indexes within 24 hours of admission(total number of white blood cells,neutrophils and lymphocytes;C-reactive protein,procalcitonin,D-dimer,albumin)were collected.Multivariate logistic regression analysis was used to identify the risk factors for severe COVID-19 in maintenance hemodialysis patients.Results There were statistically significant differences in age,aCCI,total lymphocyte count,C-reactive protein and D-dimer between the two groups(P<0.01).Multivariate logistic regression analysis showed that older age and higher C-reactive protein level were the independent risk factors for severe COVID-19 in maintenance hemodialysis patients(OR=1.256,95%CI:1.016-1.553,P=0.035;OR=1.021,95%CI:1.001-1.041,P=0.041).Conclusion The COVID-19 vaccination rate of maintenance hemodialysis patients is low,the overall age is older.Older age and higher level of C-reactive protein are independent risk factors for severe COVID-19 in maintenance hemodialysis patients.