Objectives: Since the outbreak of coronavirus disease 2019 (COVID-19), it has spread rapidly in China and many other countries. The rapid increase in the number of cases has caused widespread panic among people and has become the main public health problem in the world. Severe patients often have difficult breathing and/or hypoxemia after 1 week of onset. A few critically ill patients may not only rapidly develop into acute respiratory distress syndrome, but also may cause coagulopathy, as well as multiple organs failure (such as heart, liver and kidney) or even death. This article is to analyze the predictive role of clinical features in patients with COVID-19 for severe disease, so as to help doctor monitor the severity-related features, restrain the disease progress, and provide a reference for improvement of medical treatment.
Methods: The clinical data of 208 patients with COVID-19 who were isolated and treated in Changsha Public Health Treatment Center from January 17, 2020 to March 14, 2020 were collected. All patients were the mild and ordinary adult patients on admission, including 105 males and 103 females from 19 to 84 (median age 44) years old. According to the "Program for the diagnosis and treatment of novel coronavirus (COVID-19) infected pneumonia (Trial version 7)" issued by the General Office of National Health Committee and Office of State Administration of Traditional Chinese Medicine as the diagnostic and typing criteria. According to progression from mild to severe disease during hospitalization, the patients were divided into a mild group (n=183) and a severe transformation group (n=25). The clinical features such as age, underlying disease, blood routine, coagulation function, blood biochemistry, oxygenation index, and so on were analyzed. Among them, laboratory tests included white blood cell (WBC), lymphocytes (LYM), neutrophil (NEU), hemoglobin (Hb), platelet (PLT), prothrombin time (PT), plasma fibrinogen (Fib), activated partial prothrombin time (APTT), thrombin time (TT), D-dimer, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK), creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and oxygen partial pressure in arterial blood. Partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2) was calculated. The variables with statistical significance were analyzed by logistic regression analysis.
Results: Patients in the severe transformation group had more combined underlying diseases than those in the mild group (P<0.05). From the perspective of disease distribution, patients in the severe transformation group had more combined hypertension (P<0.05). In the severe transformation group, PT was significantly longer, the levels of Fib, ALT, AST, CK, LDH, and CRP were significantly higher than those in the mild group (P<0.05 or P<0.001), while LYM, ALB, and PaO2/FiO2 were significantly lower than those in the mild group (P<0.05 or P<0.001). Logistic regression analysis was performed on clinical features with statistically significant differences. Combined with hypertension, LYM, PT, Fib, ALB, ALT, AST, CK, LDH, and CRP as independent variables, and having severe disease or not was the dependent variable. The results show that combined hypertension, decreased LYM, longer PT, and increased CK level were independent risk factors that affected the severity of COVID-19 (P<0.05).
Conclusions: The patients with mild COVID-19 who are apt to develop severe diseases may be related to combined hypertension, decreased LYM, and longer PT, and increased CK level. For the mild patients with these clinical features, early intervention may effectively prevent the progression to severe diseases.
目的: 2019冠状病毒病(coronavirus disease 2019，COVID-19)疫情暴发以来，已在中国和其他许多国家迅速传播，病例数量的急剧增加引起了人们的普遍恐慌，已成为目前全球主要的公共卫生问题。重症患者多在发病1周后出现呼吸困难和/或低氧血症，少数危重症患者不仅可能迅速发展为急性呼吸窘迫综合征，还可能引起凝血功能障碍，以及心、肝、肾等多器官功能衰竭甚至死亡。本研究通过分析COVID-19患者临床特征对重症化的预测作用，旨在为临床医师监测患者临床特征相关变化，阻止疾病进展，提高该病的医疗救治水平提供参考依据。方法: 收集2020年1月17日至3月14日在长沙市公共卫生救治中心集中收治的208例入院时为轻型和普通型的成人COVID-19患者的临床资料，其中男105例，女103例，年龄19~84(中位年龄44)岁。按照国家卫生健康委员会办公厅和国家中医药管理局办公室印发的《新型冠状病毒肺炎诊疗方案(试行第七版)》作为诊断和分型标准。根据住院期间是否进展至重症，将患者分为轻症组(n=183)和重症转化组(n=25)，对患者的年龄、基础疾病、入院时血常规、凝血功能、血生化、氧合指数等临床特征进行比较和分析，其中实验室检查包括：白细胞(white blood cell，WBC)、淋巴细胞(lymphocytes，LYM)、中性粒细胞(neutrophil，NEU)、血红蛋白(hemoglobin，Hb)、血小板(platelet，PLT)、凝血酶原时间(prothrombin time，PT)、血浆纤维蛋白原(plasma fibrinogen，Fib)、活化部分凝血酶原时间(activated partial prothrombin time，APTT)、凝血酶时间(thrombin time，TT)、D-二聚体(D-dimer)、总胆红素(total bilirubin，TBIL)、白蛋白(albumin，ALB)、谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)、血尿素氮(blood urea nitrogen，BUN)、血肌酐(serum creatinine，Cr)、肌酸激酶(creatine kinase，CK)、肌酸激酶同工酶-MB(creatine kinase isoenzyme-MB，CK-MB)、乳酸脱氢酶(lactate dehydrogenase，LDH)、C反应蛋白(C-reactive protein，CRP)及动脉血氧分压。计算氧合指数(partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen，PaO2/FiO2)。对有统计学意义的变量进行logistic回归分析。结果: 重症转化组较轻症组患者合并的基础疾病更多(P<0.05)；从疾病分布来看，重症转化组合并高血压病更多(P<0.05)。重症转化组较轻症组PT延长，Fib，ALT，AST，CK，LDH及CRP水平显著升高(P<0.05或P<0.001)，LYM，ALB及PaO2/FiO2显著降低(P<0.05或 P<0.001)。以差异有统计学意义的临床特征，即合并高血压病，LYM，PT，Fib，ALB，ALT，AST，CK，LDH及CRP为自变量，以是否重症化为因变量，进行logistic回归分析，结果显示合并高血压病、LYM降低、PT延长、CK升高是影响COVID-19患者发生重症化的独立危险因素(P<0.05)。结论: 轻症COVID-19患者的重症化可能与合并高血压病、LYM降低、PT延长、CK升高有关，针对有这些临床特征的轻症患者及早进行干预，可能有效阻止疾病进展至重症化，提高疾病的治愈率。.
Keywords: clinical feature; coronavirus disease 2019; pneumonia; prediction; severity.