| Citation: |
WANG Xue, YANG Jian-jian, TAO Yu, et al. Risk factors and their influence on the COVID-19 patients with different outcome[J]. Chin J Clin Med, 2020, 27(2): 183-188. DOI: 10.12025/j.issn.1008-6358.2020.20200490
|
To retrospectively analyze the clinical characteristics of COVID-19 cured and dead patients, analyze the differences, and provide theoretical basis for clinical diagnosis and treatment.
Totally, 113 COVID-19 patients treated in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 10 to February 15, 2020 were divided into cured group (n=69) and death group (n=44). The clinical features, laboratory examination and imaging results of the two groups were collected, and the differences between the two groups and their relationship with prognosis were analyzed.
113 COVID-19 patients with an average age of (58.6±15.9) years old, includes 68 males and 45 females. Compared with the cured group, the patients in the death group were older, the proportion of males was higher, the proportion of complications was higher, and the differences were statistically significant (P < 0.05). In terms of imaging, the death group was more likely to show diffuse infection of both lungs (P < 0.05). In the laboratory examination, the leukocyte count and neutrophil count of the death group were significantly higher than those of the cured group, while the lymphocyte count was significantly lower (P < 0.05). Among the inflammation related indexes, C-reactive protein (CRP), ferritin, D-D dimer, lactate dehydrogenase (LDH), interleukin 2 receptor (IL-2R), IL-6, IL-8, IL-10 and tumor necrosis factor (TNF-α) in the death group were significantly higher than those in the cured group. Receiver operating characteristic (ROC) curve analysis of indexes with statistical differences showed that the area under the curve of D-D dimer was higher than other indexes, with sensitivity of 90.3% and specificity of 90.2%.
The risk of death is higher in the elderly, male patients with underlying disease. The high levels of CRP, D-D dimer, IL-2R and other cytokines suggest poor prognosis. D-D dimer has a high predictive value for the prognosis of patients. Comprehensive consideration of various indicators is more helpful to judge the outcome of patients and guide treatment.
| [1] |
武汉市卫生健康委员会.武汉市卫健委关于当前我市肺炎疫情的情况通报[EB/OL]. http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989.
|
| [2] |
HUI D S, I AZHAR E, MADANI T A, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health-the latest 2019 novel coronavirus outbreak in Wuhan, China[J]. Int J Infect Dis, 2020, 91:264-266.
|
| [3] |
World Health Organization. Novel coronavirus(2019-nCoV): situation report-35[EB/OL]. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200224-sitrep-35-covid-19.pdfsfvrsn=1ac4218d_2.
|
| [4] |
陈大明, 赵晓勤, 缪有刚, 等.全球冠状病毒研究态势分析及其启示[J].中国临床医学, 2020, 27(1):1-12. http://www.c-jcm.com/zglcyx/ch/reader/view_abstract.aspx?file_no=20200101&flag=1
|
| [5] |
国家卫生健康会.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[EB/OL]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2/files/b218cfeb1bc54639af227f922bf6b817.pdf.
|
| [6] |
中国疾病预防控制中心新型冠状病毒肺炎应急响应机制流行病学组.新型冠状病毒肺炎流行病学特征分析[J].中华流行病学杂志, 2020, 41(2):145-151. http://d.old.wanfangdata.com.cn/Periodical/zgzxyjhjjzz202001010
|
| [7] |
HUANG C, WANG Y, LI X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395(10223):497-506.
|
| [8] |
汪锴, 康嗣如, 田荣华, 等.新型冠状病毒肺炎胸部CT影像学特征分析[J].中国临床医学, 2020, 27(1):27-31. http://www.c-jcm.com/zglcyx/ch/reader/view_abstract.aspx?file_no=20200103&flag=1
|
| [9] |
SIWICKA-GIEROBA D, MALODOBRY K, BIERNAWSKA J, et al. The neutrophil/lymphocyte count ratio predicts mortality in severe traumatic brain injury patients[J]. J Clin Med, 2019, 8(9).pii:E1453.
|
| [10] |
MISSOV E, BOULARAN A M, BONIFACJ C, et al. Prognostic value of myocardial lactate dehydrogenase subunit ratio in heart transplant recipients[J]. J Heart Lung Transplant, 1998, 17(10):959-968.
|
| [11] |
RUSSELL J A. Genetics of coagulation factors in acute lung injury[J]. Crit Care Med, 2003, 31(4 Suppl):S243-S247. DOI: 10.1097-01.CCM.0000057870.61079.3E/
|
| [12] |
CHANNAPPANAVAR R, PERLMAN S. Pathogenic human coronavirus infections:causes and consequences of cytokine storm and immunopathology[J]. Semin Immuno-pathol, 2017, 39(5):529-539.
|
| [13] |
LEE D W, GARDNER R, PORTER D L, et al. Current concepts in the diagnosis and management of cytokine release syndrome[J]. Blood, 2014, 124(2):188-195.
|
| [14] |
中国临床试验注册中心.羟氯喹对新型冠状病毒(COVID-19)的治疗疗效研究[EB/OL]. http://www.chictr.org.cn/showproj.aspxproj=48880.
|
| [15] |
TANAKA T, NARAZAKI M, MASUDA K, et al. Regulation of IL-6 in immunity and diseases[J]. Adv Exp Med Biol, 2016, 941:79-88. http://d.old.wanfangdata.com.cn/OAPaper/oai_pubmedcentral.nih.gov_3838924
|
| [16] |
KULDANEK S A, KELHER M, SILLIMAN C C. Risk factors, management and prevention of transfusion-related acute lung injury:a comprehensive update[J]. Expert Rev Hematol, 2019, 12(9):773-785.
|
| [17] |
KIDO H, TAKAHASHI E, KIMOTO T. Role of host trypsin-type serine proteases and influenza virus-cytokine-trypsin cycle in influenza viral pathogenesis. Pathogenesis-based therapeutic options[J]. Biochimie, 2019, 166:203-213.
|
| [18] |
TANAKA T, NARAZAKI M, KISHIMOTO T. Immuno-therapeutic implications of IL-6 blockade for cytokine storm[J]. Immunotherapy, 2016, 8(8):959-970.
|
| [19] |
HUNTER C A, JONES S A. IL-6 as a keystone cytokine in health and disease[J]. Nat Immunol, 2015, 16(5):448-457.
|
DownLoad: