Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease
Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease
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DOI：
10.1097/cm9.0000000000000775
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发表时间：
2020-05-05
影响因子：
6.1
通讯作者：
Hu Yi
中科院分区：
文献类型：
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作者：
Liu Wei;Tao Zhao-Wu;Hu Yi
背景自二零一九年十二月初以来，二零一九年新型冠状病毒病（COVID-19）在中国湖北省武汉市引发肺炎疫情。本研究旨在调查影响COVID-19患者肺炎进展的因素。相关结果将用于评估预后，并找到COVID-19肺炎的最佳治疗方案。方法对2019冠状病毒核酸检测阳性的患者进行研究。患者于2019年12月30日至2020年1月15日期间在武汉的3家三级医院住院。收集个体数据、实验室指标、影像学特征和临床数据，并进行统计学分析。根据临床分型结果，将患者分为进展组或改善/稳定组。使用独立样本t检验或Mann-Whitney U检验分析连续变量。使用卡方检验或Fisher精确检验分析分类变量。Logistic回归分析疾病进展的危险因素。结果78例COVID-19诱导的肺炎患者符合纳入标准，并被纳入本研究。住院后2周的疗效评价表明，11例患者（14.1%）恶化，67例患者（85.9%）改善/稳定。进展组的患者年龄显著大于疾病改善/稳定组（66 [51，70] vs. 37 [32，41]岁，U = 4.932，P = 0.001）。进展组有吸烟史的患者比例显著高于改善/稳定组（27.3% vs. 3.0%，卡方（2）= 9.291，P = 0.018）。对于所有78例患者，发热是最常见的初始症状，进展组入院时的最高体温显著高于改善/稳定组（38.2 [37.8，38.6] vs. 37.5 [37.0，38.4] ℃，U = 2.057，P = 0.027）。此外，进展组中呼吸衰竭患者比例（54.5% vs. 20.9%，chi（2）= 5.611，P = 0.028）和呼吸频率（34 [18，48] vs. 24 [16，60]次/min，U = 4.030，P = 0.004）显著高于改善/稳定组。与改善/稳定组相比，进展组的C反应蛋白显著升高（38.9 [14.3，64.8] vs. 10.6 [1.9，33.1] mg/L，U = 1.315，P = 0.024）。进展组的白蛋白显著低于改善/稳定组（36.62 +/- 6.60 vs. 41.27 +/- 4.55 g/L，U = 2.843，P = 0.006）。与改善/稳定组相比，进展组患者更可能接受高水平呼吸支持（chi（2）= 16.01，P = 0.001）。多因素Logistic回归分析显示，年龄（比值比[OR]，8.546; 95%置信区间[CI]：1.628-44.864; P = 0.011），吸烟史（OR，14.285; 95%CI：1.577-25.000; P = 0.018），入院时最高体温（OR，8.999; 95%CI：1.036-78.147，P = 0.046），呼吸衰竭（OR，8.772，95% CI：1.942-40.000; P = 0.016），白蛋白C反应蛋白（OR为10.530; 95%CI为1.224-34.701，P = 0.028）是疾病进展的危险因素。结论确定了导致COVID-19肺炎进展的几个因素，包括年龄、吸烟史、入院时的最高体温、呼吸衰竭、白蛋白和C反应蛋白。这些结果可用于进一步增强COVID-19肺炎的管理能力。
Background Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia. Methods Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to 3 tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-squared test or Fisher's exact test. Logistic regression analysis was performed to explore the risk factors for disease progression. Results Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] vs. 37 [32, 41] years, U = 4.932, P = 0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, chi(2) = 9.291, P = 0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6] vs. 37.5 [37.0, 38.4]degrees C, U = 2.057, P = 0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, chi(2) = 5.611, P = 0.028) and respiratory rate (34 [18, 48] vs. 24 [16, 60] breaths/min, U = 4.030, P = 0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] vs. 10.6 [1.9, 33.1] mg/L, U = 1.315, P = 0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62 +/- 6.60 vs. 41.27 +/- 4.55 g/L, U = 2.843, P = 0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (chi(2) = 16.01, P = 0.001). Multivariate logistic analysis indicated that age (odds ratio [OR], 8.546; 95% confidence interval [CI]: 1.628-44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; P = 0.003), and C-reactive protein (OR, 10.530; 95% CI: 1.224-34.701, P = 0.028) were risk factors for disease progression. Conclusions Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature at admission, respiratory failure, albumin, and C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.