Prognostic Factors for COVID-19 Pneumonia Progression to Severe Symptoms Based on Earlier Clinical Features: A Retrospective Analysis.
Prognostic Factors for COVID-19 Pneumonia Progression to Severe Symptoms Based on Earlier Clinical Features: A Retrospective Analysis.
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基于早期临床特征的 COVID-19 肺炎进展为严重症状的预后因素：回顾性分析。
DOI：
10.3389/fmed.2020.557453
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发表时间：
2020
影响因子：
3.9
通讯作者：
Deng X
中科院分区：
文献类型：
--
作者：
Huang H;Cai S;Li Y;Li Y;Fan Y;Li L;Lei C;Tang X;Hu F;Li F;Deng X
大约15%-20%的新冠肺炎患者会发展为严重肺炎，如果处理不当，其中约10%会死亡。及早根据常规的临床和实验室变化对可能严重的患者进行歧视，并开始预防管理，不仅可以挽救生命，还可以减轻原本不堪重负的医疗负担。本研究收集了125例新冠肺炎患者入院后3~7天的临床和实验室资料，根据病情分为轻度组(93例)和重度组(32例)。随后的单因素和多因素Logistic回归分析显示，入院时的17个因素在轻型组和重型组之间存在显著差异，但只有与基础疾病并存、呼吸频率增加(24次/分钟)、C反应蛋白(C反应蛋白)升高(10 mg/L)和乳酸脱氢酶(LDH>；250U/L)独立地与疾病的发展相关。最后，我们用受试者工作特征曲线分析来评估它们的预后价值，发现上述四个因素不能单独预测重症肺炎的发生，尽管呼吸频率快和乳酸脱氢酶升高显著增加了预测的可信度(AUC=0.944，敏感性=0.941，特异性=0.902)。由三个或四个因素组成的组合可进一步增加预后价值。此外，入院后可测量的血清病毒RNA独立预测严重疾病的发生。总而言之，结合一般临床特征和实验室测试，可以为识别潜在的严重新冠肺炎肺炎患者提供高度自信的预后价值。
Approximately 15–20% of COVID-19 patients will develop severe pneumonia, and about 10% of these will die if not properly managed. Earlier discrimination of potentially severe patients basing on routine clinical and laboratory changes and commencement of prophylactical management will not only save lives but also mitigate the otherwise overwhelming healthcare burden. In this retrospective investigation, the clinical and laboratory features were collected from 125 COVID-19 patients who were classified into mild (93 cases) or severe (32 cases) groups according to their clinical outcomes after 3–7 days post-admission. The subsequent analysis with single-factor and multivariate logistic regression methods indicated that 17 factors on admission differed significantly between mild and severe groups but that only comorbidity with underlying diseases, increased respiratory rate (>24/min), elevated C-reactive protein (CRP >10 mg/L), and lactate dehydrogenase (LDH >250 U/L) were independently associated with the later disease development. Finally, we evaluated their prognostic values with receiver operating characteristic curve (ROC) analysis and found that the above four factors could not confidently predict the occurrence of severe pneumonia individually, though a combination of fast respiratory rate and elevated LDH significantly increased the predictive confidence (AUC = 0.944, sensitivity = 0.941, and specificity = 0.902). A combination consisting of three or four factors could further increase the prognostic value. Additionally, measurable serum viral RNA post-admission independently predicted the severe illness occurrence. In conclusion, a combination of general clinical characteristics and laboratory tests could provide a highly confident prognostic value for identifying potentially severe COVID-19 pneumonia patients.