Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
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DOI：
10.1016/s0140-6736(20)30566-3
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发表时间：
2020-03-28
期刊：
影响因子：
168.9
通讯作者：
Cao, Bin
中科院分区：
文献类型：
--
作者：
Zhou, Fei;Yu, Ting;Cao, Bin
背景2019年12月以来，武汉市中国经历了由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的2019年冠状病毒病(新冠肺炎)疫情。新冠肺炎患者的流行病学和临床特征已有报道，但死亡的危险因素和包括病毒脱落在内的详细临床病程尚未得到很好的描述。方法在这项多中心的回顾性队列研究中，我们纳入了金银滩医院和武汉肺科医院(武汉，中国)的所有经实验室证实的住院的成年新冠肺炎患者，他们于2020年1月31日出院或死亡。从电子病历中提取人口统计学、临床、治疗和实验室数据，包括病毒RNA检测的系列样本，并比较幸存者和死亡者之间的差异。采用单因素和多因素Logistic回归分析方法，对191例住院患者(金银滩医院135例，武汉市肺科医院56例)的住院死亡危险因素进行分析，其中137例已出院，54例死亡。91例(48%)患者合并疾病，其中最常见的是高血压(58例[30%])，其次是糖尿病(36例[19%])和冠心病(15例[8%])。多因素回归分析显示，高龄(优势比1.10，95%可信区间1.03-1.17，每年增加；p=0.0043)、序贯器官衰竭评估(SOFA)评分高(5.65，2.61-12.23；p
Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.Methods In this retrospective, multicentre cohort study, we included all adult inpatients (>= 18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1.10, 95% CI 1.03-1.17, per year increase; p=0.0043), higher Sequential Organ Failure Assessment (SOFA) score (5.65, 2.61-12.23; p