Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study
Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study
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DOI：
10.1016/j.cmi.2020.05.041
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发表时间：
2020-09-01
影响因子：
14.2
通讯作者：
Liu, Y. -H.
中科院分区：
文献类型：
--
作者：
Cen, Y.;Chen, X.;Liu, Y. -H.
目标：自2019年12月以来，在武汉市出现的2019新型冠状病毒病（COVID-19）在全球迅速传播。一旦患者进展到严重或危重阶段，结果不佳的风险就会急剧增加。本研究旨在调查轻度至中度 COVID-19 患者疾病进展的危险因素。方法：我们进行了一项队列研究，纳入了来自武汉三家医院的 1007 名轻度至中度 COVID-19 患者。收集临床特征和基线实验室检查结果。对患者进行为期28天的随访，观察疾病进展情况。结果：在28天的随访中，720例患者（71.50%）康复或症状稳定，222例患者（22.05%）进展为重症，22例患者（2.18%）进展为危重阶段，43例患者（4.27%）死亡。多变量 Cox 比例风险模型发现，年龄增加（风险比 (HR) 2.56，95% CI 1.97-3.33）、男性（HR 1.79，95% CI 1.41-2.28）、高血压（HR 1.44，95% CI 1.11-1.88）、糖尿病（HR 1.82，95% CI 1.11-1.88） 1.35-2.44）、慢性阻塞性肺疾病（HR 2.01，95% CI 1.38-2.93）和冠状动脉疾病（HR 1.83，95% CI 1.26-2.66）是疾病进展的危险因素。吸烟史可预防疾病进展（HR 0.56，95% CI 0.34-0.91）。降钙素原（HR 1.72，95% CI 1.02-2.90）、尿素氮（HR 1.72，95% CI 1.21-2.43）、α-羟基丁酸脱氢酶（HR 3.02，95% CI 1.26-7.21）和D-二聚体（HR 2.01，95% CI）升高基线时（1.12-3.58）也与疾病进展风险相关。结论：本研究确定了轻度至中度 COVID-19 个体疾病进展的一组危险因素。 (c) 2020 年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19.Methods: We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage.Results: During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97-3.33), male sex (HR 1.79, 95% CI 1.41-2.28), presence of hypertension (HR 1.44, 95% CI 1.11-1.88), diabetes (HR 1.82, 95% CI 1.35-2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38-2.93) and coronary artery disease (HR 1.83, 95% CI 1.26-2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34-0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02-2.90), urea nitrogen (HR 1.72, 95% CI 1.21-2.43), alpha-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26-7.21) and D-dimer (HR 2.01, 95% CI 1.12-3.58) at baseline were also associated with risk for disease progression.Conclusions: This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19. (c) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.