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.
- 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
: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.
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。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
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.