Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study
Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study
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与严重冠状病毒病 19 (COVID-19) 患者死亡结果相关的因素：病例对照研究
DOI：
10.7150/ijms.46614
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发表时间：
2020-01-01
影响因子：
3.6
通讯作者：
Zheng, Chuansheng
中科院分区：
文献类型：
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作者：
Pan, Feng;Yang, Lian;Zheng, Chuansheng
依据：迄今为止，重症COVID-19患者的临床特征探索大多来自中国武汉的同一中心。其他中心的临床数据有限。本研究旨在探索可用于临床实践的预测重症冠状病毒病（COVID-19）住院患者预后的可行参数。研究方法：在这项病例对照研究中，于2020年1月27日至2020年3月19日期间入住该新成立隔离中心的重症COVID-19患者被分为出院组和死亡事件组。临床资料的收集和分析有以下目的：1。两组基本特征比较; 2.采用Logistic回归分析入院死亡的危险因素; 3.两组患者治疗过程中影像学及实验室指标的动态变化。结果：纳入124例重症COVID-19患者，分为出院组（n=35）和死亡事件组（n=89）。性别、SpO 2、呼吸频率、舒张压、中性粒细胞、淋巴细胞、C-反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）和D-二聚体与使用双变量logistic回归确定的死亡事件显著相关。进一步的多因素Logistic回归显示了显著的模型拟合，C指数为0.845（p<0.001），其中SpO 2 ≤ 89%、淋巴细胞≤0.64×109/L、CRP>77.35mg/L、PCT>0.20μg/L、LDH> 481 U/L为独立危险因素，OR值分别为2.959、4.015、2.852、3.554、3.185，P<0.04。病程中死亡组淋巴细胞持续下降，CRP、PCT、IL-6、中性粒细胞、LDH、D-二聚体、心肌肌钙蛋白I（cTnI）、脑利钠肽（BNP）升高，CD 4 +/CD 8 + T淋巴细胞比值升高，出院组上述指标稳定或改善。结论：入院时SpO 2、淋巴细胞、CRP、PCT和LDH水平可以预测重症COVID-19患者的预后。除急性呼吸窘迫综合征外，全身性炎症伴心功能不全可能是严重COVID-19死亡事件的主要原因。
Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.