Association between major complications and underlying diseases in COVID-19 patients: An analysis of 2 079 cases
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摘要:
背景 2019年12月下旬湖北省武汉市发现了多例新型冠病毒肺炎(COVID-19)患者，在短时间内播散至我国其他省份。大部分患者感染后为轻型及普通型，小部分患者，尤其是有基础疾病的患者或老年人，易合并严重并发症，死亡率显著升高。 目的 本文对新型冠状病毒肺炎患者主要并发症与基础疾病的关联性进行分析，为临床诊治中预判严重并发症和早期医疗干预提供依据。 方法 选取火神山医院2020年2月4日- 3月29日收治入院的2 079例COVID-19患者进行回顾性研究，并对与死亡事件关联性最显著的并发症进行logistic回归分析。 结果 2 079例患者中，男性1 085例(52.19%)，女性994例(47.81%)，年龄14～100(58.46±14.48)岁。合并至少一种基础疾病者1 088例(52.33%)，发生至少一种并发症者173例(8.32%)。死亡患者49例(2.36%)，死亡与生存两组间无性别差异(P＞0.05)，但年龄分布差异有统计学意义(P＜0.001)。多脏器功能衰竭(χ2=696.596，P＜0.001)、呼吸衰竭(χ2=391.827，P＜0.001)、休克(χ2=389.881，P＜0.001)是与死亡事件关联性最显著的3种主要并发症。低蛋白血症(OR=4.010，P=0.038)、心脏病(OR=4.088，P=0.002)、糖尿病(OR=2.953，P=0.017)与多脏器功能衰竭存在显著关联。并且低蛋白血症(OR=5.936，P＜0.001)、心脏病(OR=3.541，P=0.001)、糖尿病(OR=2.447，P=0.013)也与呼吸衰竭存在显著关联；低蛋白血症还与休克存在显著关联(OR=19.797，P＜0.001)。 结论 基础疾病可增加并发症的发生风险，尤其是合并低蛋白血症、心脏病和糖尿病的患者，早期关注、及时干预可能改善其临床结局。 Abstract:Background In late December 2019, a series of cases of Coronavirus Disease 2019 were discovered in Wuhan, Hubei. The disease rapidly spread to other provinces in China and continued to spread around the world. Most patients manifested as mild or moderate type. Some patients, especially those with underlying diseases or the elderly, are prone to have severe complications and significantly higher mortality rates. Objective To analyze the association between the major complications of patients with Coronavirus Disease 2019 (COVID-19) and underlying diseases, and provide evidences for clinical prediction of severe complications and early medical intervention. Methods In this retrospective study, 2 079 confirmed COVID-19 cases in Huoshenshan Hospital were included from February 4, 2020 to March 30, 2020. Three kinds of most significant complications related to death were recorded. Logistic regression analysis was performed analyze the impact of their underlying diseases. Results Of the 2 079 patients, 1 085 were male (52.19%) and 994 were female (47.81%). The patients aged 14 to 100 (58.460±14.477) years, 1 088 cases (52.33%) had at least one underlying disease, and 173 cases (8.32%) developed at least one complication. Death occurred in 49 patients (2.36%). There was significant difference in age between the survival group and the death group (P＜0.001), but no significant difference was found in sex. Multiple organ failure (χ2=696.596, P＜0.001), respiratory failure (χ2=391.827, P＜0.001), and shock (χ2=389.881, P＜0.001) were the three major complications significantly associated with death. Hypoproteinemia (OR=4.010, P=0.038), heart disease (OR=4.088, P=0.002) and diabetes (OR=2.953, P=0.017) were associated with multiple organ failure. Hypoproteinemia (OR=5.936, P＜0.001), heart disease (OR=3.541, P=0.001) and diabetes (OR=2.447, P=0.013) were also significantly associated with respiratory failure. Hypoproteinemia (OR=19.797, P＜0.001) was significantly associated with shock. Conclusion Underlying diseases can increase the risk of complications, especially for patients with hypoproteinemia, heart disease and diabetes. Early attention and timely intervention can potentially improve their clinical outcomes. -
Key words:
- COVID-19 /
- multiple organ failure /
- respiratory failure /
- shock /
- hypoproteinemia
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表 1 COVID-19患者基本资料
Table 1. Basic information of the COVID-19 patients
Characteristics Clinical outcome χ2/t P Survival
(n=2 030)Death
(n=49)Sex/(n, %) 3.461 0.063 Male 1 053(51.87) 32(65.31) Female 977(48.13) 17(34.69) Age 58.2±14.4 70.9±10.9 7.990 ＜0.001 ＜ 45 yrs 376(18.52) 1(2.04) 45-69 yrs 1 185(58.37) 15(30.61) 52.343 ＜0.001 ＞ 69 yrs 469(23.10) 33(67.35) Underlying
diseases/(n, %)1 051(51.77) 37(75.51) 10.807 0.001 Complication/(n, %) 138(6.80) 35(71.43) 253.568 0.000 Duration of
hospitalization/d14.76±8.57 15.88±12.76 0.609 0.545 
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表 2 生存组与死亡两组并发症发生率比较(n, %)
Table 2. Comparison of complication rates between the survival group and the death group (n, %)
Complication Survivor
(n=2 030)Death
(n=49)χ2 P Multiple organ failure 3(0.15) 20(40.82) 686.596 0.000 Respiratory failure 22(1.08) 21(42.86) 391.827 0.000 Shock 2(0.10) 12(24.49) 389.881 0.000 Cardiac insufficiency 6(0.30) 13(26.53) 335.260 0.000 ARDS 7(0.34) 11(22.45) 247.216 0.000 Sepsis 0(0.00) 5(10.20) 167.289 0.000 Renal insufficiency 12(0.59) 6(12.24) 62.737 0.000 Electrolytedisturbance 24(1.18) 7(14.29) 47.363 0.000 DIC 0(0.00) 2(4.08) 45.904 0.001 Blood diseases 29(1.43) 7(14.29) 39.231 0.000 Gastrointestinal bleeding 9(0.44) 4(8.16) 34.305 0.000 Pleural effusion 13(0.64) 3(6.12) 12.334 0.006 Hepatic insufficiency 50(2.46) 5(10.20) 8.329 0.008
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表 3 基础疾病发生情况及死亡的单因素及多因素回归分析
Table 3. Logistic regression analysis of association between underlying diseases and death
Underlying disease Prevalence/% Mortality/% Logistic regression analysis of death Univariate Multivariate P OR 95% CI P OR 95% CI Hypoproteinemia 2.31 14.58 0.000 8.085 3.429 - 19.066 0.002 4.399 1.693 - 11.432 Connective tissue diseases 1.01 4.76 0.475 2.094 0.275 - 15.921 − − − Gastrointestinal diseases 2.74 0.00 − − − − − Hepatobiliary and pancreatic diseases 6.73 0.71 0.214 0.283 0.039 - 2.069 − − − Cardiovascular diseases 8.99 8.02 0.000 4.766 2.545 - 8.924 0.003 2.858 1.433 - 5.699 Metabolic diseases 6.25 0.00 − − − − − Respiratory diseases 5.29 6.36 0.007 3.118 1.367 - 7.110 0.116 2.083 0.834 - 5.206 Blood system diseases 2.55 9.43 0.002 4.692 1.782 - 12.357 0.228 1.947 0.659 - 5.757 Nervous system diseases 5.96 6.45 0.003 3.220 1.475 - 7.026 0.530 1.319 0.556 - 3.129 Kidney diseases 4.33 7.78 0.001 3.910 1.705 - 8.964 0.132 2.039 0.807 - 5.150 Hypertension 32.08 3.90 0.002 2.450 1.387 - 4.326 0.232 1.474 0.780 - 2.784 Diabetes mellitus 14.33 5.03 0.002 2.723 1.465 - 5.065 0.054 1.947 0.989 - 3.836 Solid carcinoma 2.50 0.00 − − − − − −
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表 4 多脏器功能衰竭的单因素及多因素logistic回归分析
Table 4. Logistic regression analysis of association between underlying diseases and multiple organ failure
Underlying disease Respiratory failure Univariate Multivariate OR 95% CI P OR 95% CI P Hypoproteinemia 6.703 1.923 - 23.372 0.003 4.010 1.081 - 14.882 0.038 Connective tissue diseases 4.627 0.595 - 36.010 0.143 − − − Gastrointestinal diseases 0.000 − − − − − Hepatobiliary and pancreatic diseases 0.627 0.084 - 4.685 0.649 − − − Cardiovascular diseases 6.783 2.895 - 15.891 0.000 4.088 1.666 - 10.034 0.002 Metabolic diseases 0.000 − − − − − Respiratory diseases 1.718 0.398 - 7.421 0.469 − − − Blood diseases 3.744 0.855 - 16.395 0.080 − − − Nervous system diseases 2.399 0.703 - 8.185 0.162 − − − Kidney diseases 4.823 1.606 - 14.482 0.005 2.492 0.773 - 8.038 0.126 Hypertension 4.038 1.703 - 9.571 0.002 2.000 0.778 - 5.139 0.150 Diabetes mellitus 4.722 2.051 - 10.870 0.000 2.953 1.214 - 7.179 0.017 Solid carcinoma 0.000 − − − − −
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表 5 呼吸衰竭的单因素及多因素logistic回归分析
Table 5. Logistic regression analysis of association between underlying diseases and respiratory failure
Underlying disease Respiratory failure Univariate Multivariate OR 95% CI P OR 95% CI P Hypoproteinemia 9.461 3.977 - 22.508 0.000 5.936 2.279 - 15.464 0.000 Connective tissue diseases 0.000 − − − − − Gastrointestinal diseases 0.842 0.114 - 6.226 0.866 − − − Hepatobiliary and pancreatic diseases 0.671 0.161 - 2.803 0.584 − − − Cardiovascular diseases 5.199 2.696 - 10.024 0.000 3.541 1.724 - 7.273 0.001 Metabolic diseases 0.000 − − − − − Respiratory diseases 3.102 1.243 - 7.298 0.015 1.923 0.714 - 5.177 0.196 Blood diseases 4.159 1.430 - 12.093 0.009 1.687 0.507 - 5.614 0.394 Nervous system diseases 1.638 0.576 - 4.658 0.355 − − − Kidney diseases 3.020 1.159 - 7.867 0.024 1.594 0.544 - 4.670 0.395 Hypertension 1.867 1.018 - 3.424 0.044 1.036 0.523 - 2.051 0.920 Diabetes mellitus 2.978 1.555 - 5.705 0.001 2.447 1.204 - 4.974 0.013 Solid carcinoma 0.927 0.125 - 6.865 0.941 − − −
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表 6 休克的单因素及多因素logistic回归分析
Table 6. Logistic regression analysis of association between underlying diseases and shock
Underlying disease Respiratory failure Univariate Multivariate OR 95% CI P OR 95% CI P Hypoproteinemia 29.404 9.241 - 93.559 0.000 19.797 5.744 - 68.238 0.000 Connective tissue diseases 0.000 − − − − − Gastrointestinal diseases 0.000 − − − − − Hepatobiliary and pancreatic diseases 0.000 − − − − − Cardiovascular diseases 4.573 1.395 - 14.995 0.012 2.265 0.605 - 8.486 0.225 Metabolic diseases 0.000 − 0.996 − − − Respiratory diseases 3.296 0.722 - 15.057 0.124 − − − Blood diseases 3.228 0.412 - 25.285 0.265 − − − Nervous system diseases 7.207 2.188 - 23.742 0.001 2.703 0.686 - 10.654 0.155 Kidney diseases 0.000 − − − − − Hypertension 1.822 0.610 - 5.442 0.283 − − − Diabetes mellitus 3.782 1.229 - 11.640 0.020 2.883 0.875 - 9.503 0.082 Solid carcinoma 0.000 − − − − −
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