Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
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DOI：
10.1136/bmj.m1091
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发表时间：
2020-03-26
影响因子：
105.7
通讯作者：
Ning, Qin
中科院分区：
文献类型：
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作者：
Chen, Tao;Wu, Di;Ning, Qin
目的了解2019冠状病毒病（covid-19）死亡患者的临床特征。design回顾性案例系列。中国武汉同济医院。在799名患者的队列中，分析了113名死亡患者和161名诊断为covid-19的康复患者。数据收集至2020年2月28日。主要观察指标：临床特征和实验室结果从电子病历中收集数据。结果死亡患者的中位年龄（68岁）明显大于康复患者（51岁）。男性在死亡患者（83例；73%）中比在康复患者（88例；55%）中更占优势。慢性高血压和其他心血管合并症在死亡患者中（54例（48%）和16例（14%））比康复患者（39例（24%）和7例（4%））更常见。死亡患者中呼吸困难、胸闷和意识障碍（70（62%）、55（49%）和25(22%)）比康复患者（50（31%）、48（30%）和1(1%)）更常见。死亡患者从发病到死亡的中位时间为16天（四分位数范围为12.0-20.0）。56例（50%）死亡患者出现白细胞增多，6例（4%）康复，103例（91%）和76例（47%）淋巴细胞减少。死亡患者的丙氨酸转氨酶、天冬氨酸转氨酶、肌酐、肌酸激酶、乳酸脱氢酶、心肌肌钙蛋白I、n端前脑钠肽和d -二聚体浓度明显高于康复患者。死亡患者常见的并发症包括急性呼吸窘迫综合征（113;100%）、I型呼吸衰竭（18/35;51%）、脓毒症（113;100%）、急性心脏损伤（72/94;77%）、心力衰竭（41/83;49%）、碱中毒（14/35;40%）、高钾血症（42;37%）、急性肾损伤（28;25%）和缺氧性脑病（23;20%）。有心血管合并症的患者更容易出现心脏并发症。无论有无心血管病史，急性心脏损伤和心力衰竭在死亡患者中更为常见。结论严重急性呼吸综合征冠状病毒2型感染可引起肺部和全身炎症，高危患者可出现多脏器功能障碍。急性呼吸窘迫综合征和呼吸衰竭、败血症、急性心脏损伤和心力衰竭是covid-19加重期间最常见的重症并发症。
OBJECTIVETo delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.DESIGNRetrospective case series.SETTINGTongji Hospital in Wuhan, China.PARTICIPANTSAmong a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.MAIN OUTCOME MEASURESClinical characteristics and laboratory findings were obtained from electronic medical records with data collectionRESULTSThe median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.CONCLUSIONSevere acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.