南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (08): 1112-1118.doi: 10.12122/j.issn.1673-4254.2020.08.07

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成人COVID-19重症及危重症患者的临床特征分析

谢维当，朱世杰，刘亚楠，白煜佳，傅卫军，陈 辉，陈仲清，张建武   

  • 出版日期:2020-08-20 发布日期:2020-08-20
  • 基金资助:

Clinical features of severe or critical ill patients with COVID-19

  

  • Online:2020-08-20 Published:2020-08-20

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摘要： 目的 探讨新型冠状病毒肺炎（COVID-19）重症及危重症患者的临床特征。方法 对2020年1月~2020年3月湖北省洪湖市人民医院75例COVID-19重症及危重症患者临床资料进行回顾性分析。结果 75例患者重型43例，危重型32例，男性41例 （54.67），女性34例（45.33%），年龄58.1±15.9岁，49.3%患者有基础疾病史，主要临床表现为发热（78.67%）和咳嗽（70.67%）等。与重型患者比较，危重型患者在年龄>60岁患者比例、入院时WBC计数、hsCRP、PCT、凝血酶原时间、D二聚体、ALT、CRE、LDH、cTnI、NT-proBNP等均较重症组明显升高，有显著性统计学差异（P<0.05）。单因素logistic 回归分析结果显示，年龄>60 岁、WBC计数升高、hs-CRP升高、凝血酶原时间延长、D二聚体升高、NT-proBNP升高、cTnI升高是 COVID-19 危重型的相关因素 （P均<0.05）。进一步多因素logistic回归分析结果显示，年龄>60岁（OR=8.165，95%CI 1.483，45.576，P=0.017），凝血酶原时间延长（OR=7.516，95%CI 2.568，21.998，P=0.006）和NT-proBNP 升高（OR=6.194，95%CI 1.305，29.404，P=0.022）是 COVID-19 危重型的独立相关因素。结论 年龄大于60岁、凝血酶原时间延长和NT-proBNP升高是COVID-19危重症患者的重要临床特征，可能为危重症患者的早期预警因素。

Abstract: Objective To analyze the clinical features of severe or critical ill adult patients with coronavirus disease (COVID-19). Methods The clinical data of 75 patients with severe or critical COVID-19 in Honghu People’s Hospital from January to March in 2020 were collected. Results Of the 75 patients with COVID-19 pneumonia, 41 were male (54.67% ) and 34 were female (45.33%) with a mean age of 67.53 ±12.37 years; 43 patients had severe and 32 had critical COVID-19, and 49.3% of the patients had underlying diseases. The main clinical manifestations included fever (78.67%) and coughing (70.67%). Compared with the severe patients, the critically ill patients had higher proportions of patients over 60 years old with elevated white blood cell count, increased prothrombin time, and higher levels of hsCRP, PCT, D-dimer, ALT, LDH, cTnI and NT-proBNP. Univariate logistic regression analysis showed that an age over 60 years, leukocytosis, hs-CRP elevation, prolonged prothrombin time, and increased levels of D-dimer, NT-proBNP and cTnI were associated with severe COVID-19. Multivariate logistic regression showed that an age over 60 years (OR=8.165, 95% CI: 1.483-45.576, P=0.017), prolonged prothrombin time (OR=7.516, 95% CI: 2.568-21.998, P=0.006) and elevated NT-proBNP (OR=6.194, 95% CI: 1.305-29.404, P=0.022) were independent risk factors for critical type of COVID-19. Conclusion An age over 60 years, a prolonged prothrombin time and elevated NT-proBNP level are important clinical features of critically ill patients with COVID-19, and can be deemed as early warning signals for critical conditions of the disease.