Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan
Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan
复制标题
DOI：
10.1016/j.jaci.2020.04.006
复制
发表时间：
2020-07-01
影响因子：
14.2
通讯作者：
Zhao, Jianping
中科院分区：
文献类型：
--
作者：
Li, Xiaochen;Xu, Shuyun;Zhao, Jianping
背景：于二零一九年十二月，武汉爆发2019冠状病毒病（COVID-19）疫情。关于严重COVID-19患者的临床特征和结局的数据有限。目的：我们试图评估COVID-19患者入院时的严重程度、并发症、治疗和结局。方法：回顾性入组2020年1月26日至2020年2月5日在同济医院住院的COVID-19患者，并随访至2020年3月3日。通过多变量二元logistic模型分析了严重COVID-19的潜在风险因素。采用考克斯比例风险回归模型对重症患者进行生存分析。结果：548例患者入院时确定269例（49.1%）为重症患者。年龄较大、基础高血压、高细胞因子水平（IL-2 R、IL-6、IL-10和TNF-α）和高乳酸脱氢酶水平与入院时重度COVID-19显著相关。COVID-19患者的哮喘患病率为0. 9%，明显低于武汉成年人群。在平均32天的随访期内，非重症患者的估计死亡率为1.1%，重症患者为32.5%。生存分析显示，男性、年龄较大、白细胞增多、高乳酸脱氢酶水平、心脏损伤、高血糖和使用大剂量皮质类固醇与严重COVID-19患者的死亡有关。结论：年龄较大、高血压和高乳酸脱氢酶水平的患者需要仔细观察和早期干预，以防止严重COVID-19的潜在发展。心脏损伤、高血糖和使用大剂量皮质类固醇的严重男性患者死亡风险高。
Background: In December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited.Objective: We sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19.Methods: Patients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients.Results: We identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-alpha), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19.Conclusions: Patients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.