重症新型冠状病毒肺炎患者的临床特征及预后风险因素分析

车霄; 王乐霄; 赵磊; 黄锐; 徐哲; 王福生

doi:10.3969/j.issn.2095-5227.2023.02.001

重症新型冠状病毒肺炎患者的临床特征及预后风险因素分析

Clinical characteristics and prognostic factors of severe COVID-19

摘要

摘要:
背景新型冠状病毒肺炎疫情初期重症患者比例高，其临床特征、预后风险因素有待进一步明确。
目的回顾性分析新冠肺炎重症患者的临床特征并分析预后风险因素。
方法以2020年319例新冠肺炎重症患者为研究对象，分析患者的基线临床特征、实验室检验指标、CT影像学特点、临床评分等。分析存活患者与死亡患者的差异及死亡相关危险因素。
结果 319例重症患者中，重型262例，危重型57例。其中，11例重型患者、35例危重型患者在住院期间死亡。死亡患者中位年龄，发热等症状比例，合并基础疾病比例，出现急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)、凝血异常等并发症的比例均高于存活患者(P＜0.05)。存活患者CT主要表现为斑片影和磨玻璃影，死亡患者肺CT出现实变影、胸腔积液比例高于存活患者(P＜0.05)。入院检验显示319例重症患者C反应蛋白(C-reactive protein，CRP)、D-二聚体中位数升高，淋巴细胞计数中位数降低，但死亡患者较存活患者的升高或降低幅度都更显著(P＜0.05)。多变量logistic回归分析提示住院期间出现ARDS(OR=7.904，95% CI：1.899 ~ 32.907)与患者不良结局相关，年龄(OR=1.054，95% CI：1.005 ~ 1.105)、qSOFA评分(OR=3.787，95% CI：1.616 ~ 8.874)、CRP(OR=1.013，95% CI：1.004 ~ 1.022)、D-二聚体(OR=1.104，95% CI：1.006 ~ 1.212)越高，患者死亡风险越大(P＜0.05)。
结论合并基础疾病、并发症、感染指标异常、凝血指标异常与死亡相关，需早期识别。年龄、CRP、D-二聚体、qSOFA评分升高可作为评估患者住院死亡风险升高的预测指标。

Abstract:
Background The proportion of severe patients in the early stage of COVID-19 is high, and its clinical characteristics and prognostic risk factors need to be further clarified.
Objective To retrospectively analyze the clinical features and prognostic risk factors of severe COVID-19 patients.
Methods A total of 319 patients with severe COVID-19 in 2020 were selected as research objects. Baseline clinical characteristics, laboratory test indicators, CT imaging characteristics and clinical scores of the patients were analyzed. The differences between survived and deceased patients and mortality related risk factors were analyzed.
Results Among 319 cases of severe disease, 262 cases were severe and 57 cases were critical, 11 severe cases and 35 critical cases died during hospitalization. The median age of the dead patients, the proportion of symptoms such as fever, the proportion of underlying diseases, and the proportion of comorbidities such as ARDS and abnormal coagulation were all higher than those of the survived patients (P<0.05). The main CT manifestations of survived patients were patch shadow and ground glass shadow, and the proportions of realistic shadow and pleural effusion on lung CT of deceased patients were higher than those of survived patients (P<0.05). Admission examination showed that the median CRP and D-dimer were increased and the median lymphocyte count was decreased in 319 severe patients, but the degree of increase or decrease in deceased patients was more significant than that in survived patients (P<0.05). Multivariate logistic analysis suggested that ARDS during hospitalization (OR=7.904, 95% CI: 1.899-32.907) was associated with adverse outcomes. The higher the age (OR=1.054, 95% CI: 1.005-1.105), qSOFA score (OR=3.787, 95% CI: 1.616-8.874), CRP (OR=1.013, 95% CI: 1.004-1.022) and D-dimer (OR=1.104, 95% CI: 1.006-1.212), the greater the risk of death (P<0.05).
Conclusion Complicated with underlying diseases, comorbidities, abnormal infection index and abnormal coagulation index are associated with death, which need to be identified early. Age, CRP, D-dimer and qSOFA scores can be used as predictors to assess the risk of death in hospital.

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