COVID-19 with Different Severities: A Multicenter Study of Clinical Features
COVID-19 with Different Severities: A Multicenter Study of Clinical Features
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DOI：
10.1164/rccm.202002-0445oc
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发表时间：
2020-06-01
影响因子：
24.7
通讯作者：
Qu, Jieming
中科院分区：
文献类型：
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作者：
Feng, Yun;Ling, Yun;Qu, Jieming
基本原理：冠状病毒病（COVID-19）大流行现已成为全球健康问题。目的：我们比较了来自中国三个不同城市的COVID-19患者的临床特征、实验室检查、计算机断层扫描图像和治疗。方法：从2020年1月1日至2020年2月15日，在武汉、上海和安徽的三家医院共招募了476名患者。患者按年龄分为四组，分为三组根据中国国家卫生健康委员会发布的《2019冠状病毒病诊断和治疗指南》第五版，合并症的发生率在重度组（46.3%）和危重组（67.1%）高于中度组（37.8%）。中度组中使用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的患者多于重度组和危重组。重症组多个肺叶受累和胸腔积液的患者多于中度组。中度组在前4天内接受抗病毒药物治疗的患者多于重度组，危重组和重度组接受抗生素和皮质类固醇治疗的患者多于中度组。结论：多器官功能障碍和免疫功能受损是重症或危重症患者的典型特征。不同疾病严重程度的患者使用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的情况存在显著差异。多个肺叶受累和胸腔积液与COVID-19的严重程度相关。高龄（>= 75岁）是死亡的危险因素。
Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (>= 75 yr) was a risk factor for mortality.