Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak.
Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak.
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2019冠状病毒肺炎住院死亡的危险因素识别--来自早期爆发的损伤。
DOI：
10.1186/s12879-021-05814-4
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发表时间：
2021-01-25
影响因子：
3.7
通讯作者：
Wang Z
中科院分区：
文献类型：
--
作者：
Wang Z;Wang Z
研究2019年新型冠状病毒（COVID-19）肺炎的临床特征，并确定院内死亡的独立风险因素。这项单中心回顾性研究共纳入了2020年1月29日至2020年3月20日期间在武汉市中心医院确诊的156名新冠肺炎患者和20名健康个体。收集并分析流行病学参数、临床表现、基础疾病、实验室检查结果和疾病结局。所有入组患者的中位年龄为66岁。在101名COVID-19患者中确定了至少一种基础疾病，其中高血压是最常见的疾病，其次是心血管疾病和糖尿病。入院时最常见的症状是发热、咳嗽、呼吸困难和疲劳。与存活病例相比，住院期间死亡的患者血浆D-二聚体、肌酐、肌酸激酶、乳酸脱氢酶、乳酸水平较高，淋巴细胞百分比（LYM [%]）、血小板计数和白蛋白水平较低。大多数入组患者接受抗生素和抗病毒治疗。此外，60例患者接受皮质类固醇，51例接受静脉注射免疫球蛋白。44例患者接受无创通气，19例接受有创通气。呼吸衰竭是最常见的并发症（106例[67.9%]），其次是脓毒症（103例[66.0%]）、急性呼吸窘迫综合征（ARDS）（67例[42.9%]）和脓毒性休克（50例[32.1%]）。多变量回归分析表明，高龄（OR [比值比] = 1.098，95% CI [置信区间]：1.006-1.199，P = 0.037），从发病到入院的持续时间较短（OR = 0.853，95%CI：0.750-0.969，P = 0.015）和入院时乳酸水平升高（OR = 2.689，95%CI：1.044-6.926，P = 0.040）是COVID-19感染住院死亡的独立危险因素。入院时LYM（%）增加（OR = 0.787，95% CI：0.686-0.903，P = 0.001），预后较好。在本研究中，我们发现年龄、从发病到入院的时间、LYM（%）和入院时的乳酸水平是影响住院死亡率的独立因素。
To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia. A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006–1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750–0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044–6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686–0.903, P = 0.001) indicated a better prognosis. In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.
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