Predictors of fatality including radiographic findings in adults with COVID-19
Predictors of fatality including radiographic findings in adults with COVID-19
复制标题
死亡预测因素，包括成人 COVID-19 患者的放射学检查结果
DOI：
10.1186/s12931-020-01411-2
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发表时间：
2020-06-11
影响因子：
5.8
通讯作者：
Zhen, Guohua
中科院分区：
文献类型：
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作者：
Li, Kaiyan;Chen, Dian;Zhen, Guohua
据报道，年龄增大和d-二聚体升高是2019冠状病毒病（COVID-19）的危险因素。然而，早期影像学改变是否预示死亡仍不清楚。方法回顾性分析2020年1月31日至3月5日在中国武汉大型区域性医院同济医院隔离病房收治的所有实验室确诊患者的记录。通过RT-PCR检测痰拭子标本中SARS-CoV-2阳性，确定确诊病例。胸部CT图像由两名放射科医生独立检查。同济医院伦理委员会批准了本研究。结果102例确诊为SARS-CoV-2感染。截至3月25日，确诊患者出院85例，死亡15例，住院2例。与幸存者相比，非幸存者年龄较大（中位年龄为69岁[四分位数间距，58-77岁]对55岁[44-66岁]，p= 0.003），入院时淋巴细胞计数减少（0.5对0.9 × 109/L,p= 0.006），乳酸脱氢酶（LDH）升高（569.0对272.0 U/L,p< 0.001）， d-二聚体升高（>.1 μg/mL， 86%对37%，p= 0.002）的可能性更大。在包含上述变量的多变量回归模型中，年龄和LDH升高是病死率的独立危险因素。在第一周内有CT图像的患者中，较高的总严重程度评分和第一周内CT图像中更多的受累肺叶（5个受累肺叶）与病死率显著相关。此外，在这部分患者中，较高的总严重程度评分是包含上述变量的多变量分析中唯一的独立危险因素。结论年龄、入院时LDH升高、第一周内CT图像严重程度评分较高是成人COVID-19死亡的潜在预测因素。这些预测因素可以帮助临床医生在早期阶段识别预后不良的患者。
BackgroundOlder age and elevated d-dimer are reported risk factors for coronavirus disease 2019 (COVID-19). However, whether early radiographic change is a predictor of fatality remains unknown.MethodsWe retrospectively reviewed records of all laboratory-confirmed patients admitted to a quarantine unit at Tongji Hospital, a large regional hospital in Wuhan, China, between January 31 and March 5, 2020. Confirmed cases were defined by positive RT-PCR detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in throat-swab specimens. Chest CT images were reviewed independently by two radiologists. The Tongji Hospital ethics committee approved this study.ResultsA total of 102 patients were confirmed to have SARS-CoV-2 infection. As of March 25, 85 confirmed patients were discharged, 15 died, and 2 remained hospitalized. When compared with survivors, non-survivors were older (median age, 69 [interquartile range, 58–77] vs. 55 [44–66],p= 0.003), and more likely to have decreased lymphocyte count (0.5 vs. 0.9 × 109/L,p= 0.006), elevated lactate dehydrogenase (LDH) (569.0 vs. 272.0 U/L,p< 0.001), elevated d-dimer (> 1 μg/mL, 86% vs. 37%,p= 0.002) on admission. Older age and elevated LDH were independent risk factors for fatality in a multivariate regression model included the above variables. In a subset of patients with CT images within the first week, higher total severity score, and more involved lung lobes (5 involved lobes) in CT images within the first week were significantly associated with fatality. Moreover, in this subset of patients, higher total severity score was the only independent risk factor in a multivariate analysis incorporating the above mentioned variables.ConclusionsOlder age, elevated LDH on admission, and higher severity score of CT images within the first week are potential predictors of fatality in adults with COVID-19. These predictors may help clinicians identify patients with a poor prognosis at an early stage.