Clinical Features for Severely and Critically Ill Patients with COVID-19 in Shandong: A Retrospective Cohort Study.
Clinical Features for Severely and Critically Ill Patients with COVID-19 in Shandong: A Retrospective Cohort Study.
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DOI：
10.2147/tcrm.s280079
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发表时间：
2021
影响因子：
2.8
通讯作者：
Wang C
中科院分区：
文献类型：
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作者：
Zhou S;Xu J;Sun W;Zhang J;Zhang F;Zhao X;Wang X;Zhang W;Li Y;Ning K;Pan Y;Liu T;Zhao J;Yu J;Sun Y;Gao F;Zhang R;Fu C;Sun Y;Ouyang X;Zhang F;Hu Q;Teng H;Li Y;Zhang C;Tan W;Li J;Yin L;Dong L;Wang C
严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）是一种新型病原体，引起了2019冠状病毒病（COVID-19）的爆发，并在全球迅速蔓延。确定死亡的危险因素以及SARS-CoV-2肺炎重症和危重症患者之间临床特征的差异变得越来越重要。这项研究旨在深入了解SARS-CoV-2肺炎重症患者和危重患者之间的差异。在这项回顾性、多中心队列研究中，我们招募了62名在2020年3月12日之前确诊的SARS-CoV-2肺炎重症患者。比较重症和危重症患者从常规病历中收集的临床数据、实验室指标、胸部图像和治疗策略。还进行了单变量和多变量logistic回归分析，以确定与重度COVID-19患者进展相关的风险因素。在62例重症或危重症患者中，包括7例死亡患者，30例（48%）患者有基础疾病，其中最常见的是心血管疾病（高血压，34%，冠心病，5%）。与重症患者相比，危重患者的白色血细胞计数、降钙素原水平和D-二聚体水平明显较高，血红蛋白水平和淋巴细胞计数较低。多变量回归分析显示，入院时淋巴细胞计数低于109/L（比值比20.92，95%CI 1.76-248.18; p=0.02）增加了发生危重疾病的风险。基于多变量回归分析，入院时淋巴细胞计数较低（<109/L）是与进展为危重病的风险增加密切相关的最关键的独立因素。年龄、基础疾病（尤其是高血压和冠心病）、D-二聚体升高、血红蛋白降低、SOFA评分和APACH评分也需要考虑以预测疾病进展。血细胞计数和降钙素原水平对后期继发性细菌感染有一定的参考价值。
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel pathogen, has caused an outbreak of coronavirus disease 2019 (COVID-19) that has spread rapidly around the world. Determining the risk factors for death and the differences in clinical features between severely ill and critically ill patients with SARS-CoV-2 pneumonia has become increasingly important. This study was intended to provide insight into the difference between severely ill and critically ill patients with SARS-CoV-2 pneumonia. In this retrospective, multicenter cohort study, we enrolled 62 seriously ill patients with SARS-CoV-2 pneumonia who had been diagnosed by March 12, 2020. Clinical data, laboratory indexes, chest images, and treatment strategies collected from routine medical records were compared between severely ill and critically ill patients. Univariate and multivariate logistic regression analyses were also conducted to identify the risk factors associated with the progression of patients with severe COVID-19. Of the 62 patients with severe or critical illness, including 7 who died, 30 (48%) patients had underlying diseases, of which the most common was cardiovascular disease (hypertension, 34%, and coronary heart disease, 5%). Compared to patients with severe disease, those with critical disease had distinctly higher white blood cell counts, procalcitonin levels, and D-dimer levels, and lower hemoglobin levels and lymphocyte counts. Multivariate regression showed that a lymphocyte count less than 109/L (odds ratio 20.92, 95% CI 1.76–248.18; p=0.02) at admission increased the risk of developing a critical illness. Based on multivariate regression analysis, a lower lymphocyte count (<109/L) on admission is the most critical independent factor that is closely associated with an increased risk of progression to critical illness. Age, underlying diseases, especially hypertension and coronary heart disease, elevated D-dimer, decreased hemoglobin, and SOFA score, and APACH score also need to be taken into account for predicting disease progression. Blood cell counts and procalcitonin levels for the later secondary bacterial infection have a certain reference values.