新型冠状病毒肺炎治疗结局相关危险因素

Risk factors for treatment outcome of coronavirus disease 2019

摘要:

目的 了解新型冠状病毒肺炎（COVID-19）的流行病学及临床特征，揭示与治疗结局相关的危险因素。方法 回顾性分析武汉市某三甲医院2019年12月27日-2020年1月30日收治的确诊COVID-19患者临床资料并追踪治疗结局，按治疗结局分为生存组（好转出院）和死亡组，通过单因素及多因素分析寻找与治疗结局有关的危险因素。结果 随访至2020年3月3日，100例COVID-19患者经治疗后好转出院85例（生存组），死亡15例（死亡组）。患者中位年龄44.0岁，女性占60.0%，1例新型冠状病毒核酸检测阳性患者除胸部CT示"右肺斑片状阴影"外无其他临床表现。单因素分析发现，患者年龄≥ 60岁，既往合并慢性心脏疾病、慢性肺部疾病、脑血管疾病、糖尿病、高血压等，入院时临床分型为重型或危重型，入院时实验室检查血小板计数<100×10⁹/L、淋巴细胞计数<0.5×10⁹/L、乳酸脱氢酶≥ 250 U/L、谷丙氨酸氨基转移酶和/或天冬氨酸氨基转移酶≥ 40 U/L、血肌酐≥ 97 μmol/L、纤维蛋白原≥ 4 g/L、D-二聚体≥ 1 mg/L，治疗上未联合中药及使用机械通气（P<0.05），以上因素所占比例死亡组高于生存组，差异均有统计学意义（均P<0.05）。多因素分析结果显示，入院时临床分型为重型或危重型、合并慢性心脏病是死亡相关的独立危险因素（P<0.01）。结论 COVID-19治疗结局与多种因素相关，其中入院时COVID-19临床分型为重型或危重型、合并慢性心脏病是患者死亡的独立危险因素。

Abstract:

Objective To understand epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19), and reveal the risk factors related to treatment outcome. Methods Clinical data of patients with COVID-19 admitted to a tertiary hospital in Wuhan from December 27, 2019 to January 30, 2020 were retrospectively analyzed, treatment outcome was followed up, according to the treatment outcome, patients were divided into survival group(improved and discharged)and death group, risk factors related to treatment outcome were identified through univariate and multivariate analysis. Results During the follow-up to March 3, 2020, among 100 patients with COVID-19 after treatment, 85 cases were improved and discharged (survival group), 15 cases died (death group). The median age of patients was 44.0 years old, female patients accounting for 60.0%, 1 patient with positive SARS-CoV-2 nucleic acid test showed no other clinical manifestation except chest CT finding of "right lung patch opacity". Univariate analysis showed that percentage of patients in death group were all higher than survival group in the following factors:age ≥ 60 years old, had a history of chronic heart disease, chronic lung disease, cerebrovascular disease, diabetes mellitus, hypertension, severe or critical clinical types at admission, laboratory tests of platelet count<100×10⁹/L, lymphocytic cell count<0.5×10⁹/L, lactate dehydrogenase ≥ 250 U/L, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≥ 40 U/L, serum creatinine ≥ 97 μmol/L, fibrinogen ≥ 4 g/L, D-dimer ≥ 1 mg/L, without treatment of traditional Chinese medicine and mechanical ventilation (all P<0.05). Multivariate analysis showed that severe or critical clinical type and chronic heart disease are independent risk factors for death (P<0.01). Conclusion Treatment outcome of COVID-19 is related to multiple factors, severe or critical clinical types at admission and combines with chronic heart disease are independent risk factors for death.