Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis.
Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis.
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DOI：
10.1371/journal.pone.0246030
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Zeng HQ
中科院分区：
文献类型：
--
作者：
Zhang XB;Hu L;Ming Q;Wei XJ;Zhang ZY;Chen LD;Wang MH;Yao WZ;Huang QF;Ye ZQ;Cai YQ;Zeng HQ
自 2019 年 12 月下旬在中国武汉爆发以来，2019 年冠状病毒病 (COVID-19) 已成为全球大流行病。我们分析并比较了幸存者和非幸存者之间的临床、实验室和放射学特征，并确定了死亡的危险因素。回顾性收集中国湖北省两个中心的临床和实验室变量、放射学特征、治疗方法和并发症。进行 Cox 回归分析以确定死亡的危险因素。共有 432 名患者入组，患者中位年龄为 54 岁。总死亡率为5.09%（22/432）。与幸存者组（n = 410）相比，死亡组（n = 22）年龄更大，合并症发生率更高，更容易出现呼吸困难。一些异常的实验室变量表明，在非幸存者组中检测到急性心脏损伤、肝损伤和急性肾功能不全。未存活的患者也具有较高的计算机断层扫描 (CT) 评分和较高的巩固率。最常见的导致死亡的并发症是急性呼吸窘迫综合征（ARDS）（18/22，81.8%）。多变量 Cox 回归分析显示，血红蛋白 (Hb) <90 g/L（风险比，10.776；95% 置信区间，3.075–37.766；p<0.0001），肌酸激酶 (CK-MB) >8 U/L (9.155；2.424–34.584；p = 0.001)，乳酸脱氢酶 (LDH) >245 U/L (5.963; 2.029–17.529; p = 0.001)，降钙素原 (PCT) >0.5 ng/ml (7.080; 1.671–29.992; p = 0.008)，CT 评分 >10 (39.503; p = 0.001)。 12.430–125.539；p<0.0001）是 COVID-19 死亡率的独立危险因素。入院时低 Hb、高 LDH、PCT 和 CT 评分是死亡率的预测因素，可以帮助临床医生及早识别 COVID-19 患者的不良预后。
Since the outbreak in late December 2019 in Wuhan, China, coronavirus disease-2019 (COVID-19) has become a global pandemic. We analyzed and compared the clinical, laboratory, and radiological characteristics between survivors and non-survivors and identify risk factors for mortality. Clinical and laboratory variables, radiological features, treatment approach, and complications were retrospectively collected in two centers of Hubei province, China. Cox regression analysis was conducted to identify the risk factors for mortality. A total of 432 patients were enrolled, and the median patient age was 54 years. The overall mortality rate was 5.09% (22/432). As compared with the survivor group (n = 410), those in the non-survivor group (n = 22) were older, and they had a higher frequency of comorbidities and were more prone to suffer from dyspnea. Several abnormal laboratory variables indicated that acute cardiac injury, hepatic damage, and acute renal insufficiency were detected in the non-survivor group. Non-surviving patients also had a high computed tomography (CT) score and higher rate of consolidation. The most common complication causing death was acute respiratory distress syndrome (ARDS) (18/22, 81.8%). Multivariate Cox regression analysis revealed that hemoglobin (Hb) <90 g/L (hazard ratio, 10.776; 95% confidence interval, 3.075–37.766; p<0.0001), creatine kinase (CK-MB) >8 U/L (9.155; 2.424–34.584; p = 0.001), lactate dehydrogenase (LDH) >245 U/L (5.963; 2.029–17.529; p = 0.001), procalcitonin (PCT) >0.5 ng/ml (7.080; 1.671–29.992; p = 0.008), and CT score >10 (39.503; 12.430–125.539; p<0.0001) were independent risk factors for the mortality of COVID-19. Low Hb, high LDH, PCT, and CT score on admission were the predictors for mortality and could assist clinicians in early identification of poor prognosis among COVID-19 patients.
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