西安市重症新型冠状病毒Omicron变异株感染人群临床特征及预后风险因素分析

Clinical characteristics and prognostic risk factors of SARS-CoV-2 Omicron variant-infected patients in Xi′an city

目的分析重症新型冠状病毒Omicron变异株感染人群免疫学、影像学临床特征及死亡预后风险因素。方法本研究为回顾性研究。采用非随机抽样法。选择2022年11月1日至2023年2月1日西安市第九医院确诊新型冠状病毒Omicron变异株感染重型及危重型患者为研究对象,以2023年2月1日为时间点,根据预后不同分为死亡组和生存组,收集患者人口学资料、免疫学特征[自然杀伤细胞、T淋巴细胞、B淋巴细胞、免疫球蛋白(Ig)M、IgG、IgA]及胸部定量CT,分析生存组与死亡组患者间数据的差异,利用二元logistic回归分析影响重型及危重型Omicron变异株感染人群死亡的独立危险因素。利用受试者工作特征曲线比较不同生物学标志物之间的预测价值。结果共纳入重症新型冠状病毒Omicron变异株感染患者138例,其中死亡组43例(男32例,女11例),生存组95例(男55例,女40例),2组性别构成比差异无统计学意义(χ^(2)=3.47,P=0.063)。死亡组高龄患者、危重型患者占比高于生存组(χ^(2)值分别为5.54、46.01,均P<0.05)。死亡组淋巴细胞(CD4+T淋巴细胞、CD8+T淋巴细胞及B淋巴细胞)、自然杀伤细胞计数低于生存组(均P<0.05);死亡组Ig水平与生存组相比差异无统计学意义(均P>0.05)。死亡组患者全肺病变容积和百分比高于生存组(均P<0.05),且不论在生存组还是死亡组,右肺病变容积均大于左肺病变容积(均P<0.05)。二元logistic回归分析显示:年龄≥65岁(OR=1.20,95%CI:1.05~1.37)、肺部病变范围≥552.00 ml(OR=28.18,95%CI:3.05~260.56)和合并糖尿病(OR=16.45,95%CI:1.37~198.15)是重症新型冠状病毒Omicron变异株感染人群死亡的独立危险因素。结论重症新型冠状病毒Omicron变异株感染人群存在免疫失调,其中年龄≥65岁、肺部病变范围≥552.00 ml、合并糖尿病可作为评估重症新型冠状病毒Omicron变异株感染患者死亡的独立危险因素。

Objective To analyze the clinical features and the risk factors of death prognosis in people infected with severe SARS-CoV-2 Omicron Variant in Xi′an city.Methods This was a retrospective study.A non-random sampling method was used.Patients severely infected with SARS-CoV-2 Omicron Variant in the Ninth Hospital of Xi′an from November 1,2022 to February 1,2023 were selected as research subjects.According to different prognosis on February 1,2023 as the time point,they were divided into death group and survival group.Demographic data,immunological features(NK cells,T lymphocytes,B lymphocytes,IgM,IgG,and IgA),and CT imaging characteristics of the patients were analyzed.The independent risk factors for death in people infected with Omicron variant strains were analyzed by binary logistic regression.The predictive value of different biomarkers was compared using the receiver operating characteristic curve.Results A total of 138 patients were included,with 43 cases in the death group(32 males,11 females)and 95 cases in the survival group(55 males,40 females).There was no statistically significant difference in gender between the two groups(χ^(2)=3.47,P=0.063).The proportions of elderly patients and critically ill patients in the death group were higher than those in the survival group(χ^(2)=5.54,46.01 respectively,both P<0.05).The counts of lymphocytes(CD4+T lymphocytes,CD8+T lymphocytes,and B lymphocytes)and NK cells in the death group were lower than those in the survival group(all P<0.05).There was no statistically significant difference in the level of Ig between the two groups(all P>0.05).The proportion of total lung lesion in death group was higher than that in the survival group(P<0.05).The volume of total right lung lesion was higher than that in the left lung in both the survival and death groups(both P<0.05).Binary logistic regression analysis showed:age≥65 years old(OR=1.20,95%CI:1.05-1.37),lung lesion range≥552.00 ml(OR=28.18,95%CI:3.05-260.56),and diabetes(OR=16.45,95%CI:1.37-198.15)are independent risk factors for death in people infected with SARS-CoV-2 Omicron Variant.Conclusions Immune disorders exist in people infected with SARS-CoV-2 Omicron Variant.Age≥65 years old,lung lesion range≥552.00 ml,and diabetes can be used as risk factors for evaluating hospital mortality in the patients.