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Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study.

严重冠状病毒病患者死亡结局相关因素-19 (新型冠状病毒肺炎): 病例对照研究.

  • 影响因子:2.53
  • DOI:10.7150/ijms.46614
  • 作者列表:"Pan F","Yang L","Li Y","Liang B","Li L","Ye T","Li L","Liu D","Gui S","Hu Y","Zheng C
  • 发表时间:2020-05-18
Abstract

:Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.

摘要

研究背景: 目前,武汉地区重症新型冠状病毒肺炎患者的临床特征大多来自同一中心。其他中心的临床资料有限。本研究旨在探讨临床上可用于预测严重冠状病毒病-19 (新型冠状病毒肺炎) 住院患者预后的参数。方法: 采用病例对照研究方法,将 2020 年 1 月 27 日至 20 20 0 年 3 月 19 日新成立的隔离中心收治的重症新型冠状病毒肺炎患者分为出院组和死亡事件组。临床信息收集并分析目的如下: 1.两组基本特征的比较; 2.使用logistic回归分析入院时死亡的危险因素; 3.两组间影像学和实验室参数在病程中的动态变化。结果: 纳入 124 例入院时严重新型冠状病毒肺炎患者,分为出院组 (n = 35) 和死亡事件组 (n = 89)。性别、SpO2 、呼吸频率、舒张压、中性粒细胞、淋巴细胞、C反应蛋白 (CRP) 、降钙素原 (PCT) 、乳酸脱氢酶 (LDH) 、D-二聚体与使用双变量logistic回归确定的死亡事件显著相关。进一步的多因素logistic回归显示C指数为 0.845 的模型拟合显著 (p<0.001),其中SpO2 ≤ 89%,淋巴细胞 ≤ 0.64 × 109/L,CRP>77。35mg/L、PCT>0.20 μ g/L、LDH>481U/L为独立危险因素,其or值分别为 2.959 、 4.015 、 2.852 、 3.554 、 3.185,分别 (p<0.04)。在病程中,持续降低淋巴细胞CRP、PCT、IL-6 、中性粒细胞、LDH、D-二聚体、心肌肌钙蛋白I (cTnI) 、脑钠肽 (BNP) 、死亡事件组CD4 +/CD8 + T淋巴细胞比值升高,出院组CD4 +/CD8 + T淋巴细胞比值稳定或改善。结论: 入院时SpO2 、淋巴细胞、CRP、PCT、LDH水平可预测重症新型冠状病毒肺炎患者的预后。系统性炎症诱导心功能障碍可能是严重新型冠状病毒肺炎死亡事件的主要原因,除了急性呼吸窘迫综合征。

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翻译标题与摘要 下载文献
影响因子:2.48
发表时间:2020-04-01
来源期刊:Infection
DOI:10.1007/s15010-020-01401-y
作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.

呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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