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重症新型冠状病毒肺炎患者的死亡风险因素分析
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Abstract:
目的：分析重症新型冠状病毒肺炎患者的死亡风险因素。方法：本研究为一项回顾性病例对照研究。连续性收集2022年10月至2023年4月西京医院、空军第九八六医院确诊为重症新冠肺炎的患者，按生存结局将患者分为死亡组(90例)和对照组(277例)，分析其生存情况及预后影响因素。生存资料采用logistic回归和Kaplan-Meier法进行分析。结果：单因素分析结果显示：分型、脉搏、呼吸频率、白介素-6、降钙素原、中性粒细胞计数、淋巴细胞计数、血小板计数、活化部分凝血活酶时间、D-二聚体、谷丙转氨酶、谷草转氨酶、总胆红素、胱抑素C、肌酐、乳酸脱氢酶与早期死亡显著相关(P < 0.05)。多因素Logistic回归分析结果显示：分型、脉搏、白介素-6、D-二聚体、总胆红素、胱抑素C是重症新冠患者住院死亡的独立危险因素。Kaplan-Meier生存分析显示：患者诊断为危重型、白介素-6 ≥ 135.4 pg/ml、D-二聚体 ≥ 9.175 mg/L时，生存时间显著缩短。结论：危重型、白介素-6 ≥ 135.4 pg/ml、D-二聚体 ≥ 9.175 mg/L与重症新型冠状病毒肺炎的高死亡风险有关，可作为重症新型冠状病毒肺炎患者的死亡预测指标。
Objective: To analyze the risk factors of mortality in patients with severe COVID-19. Methods: This study is a retrospective case-control study. The patients who were diagnosed as severe COVID-19 in Xijing Hospital and Air Force 986 Hospital from October 2022 to April 2023 were continuously col-lected, were divided into death group (n = 90) and control group (n = 277) by the survival outcome, then analyzing the survival and prognostic factors. Survival data were analyzed by logistic regres-sion and Kaplan-Meier method. Results: Univariate analysis showed that type, P, R, IL-6, PCT, N, L, PLT, APTT, D-dimer, ALT, AST, TBIL, CysC, CRE, LDH are significantly correlated with early death (P < 0.05). Multivariate Logistic regression analysis showed that type, P, IL-6, D-dimer, TBIL and CysC were independent risk factors for hospitalized death in severe COVID-19 patients. Kaplan-Meier survival analysis showed that the survival time was significantly shortened when the patients were diagnosed as critical type of COVID-19, IL-6 ≥ 135.4 pg/ml and D-dimer ≥ 9.175 mg/L. Conclusion: Critical type, IL-6 ≥ 135.4 pg/ml and D-dimer ≥ 9.175 mg/L are related to the high risk of death of severe COVID-19, which can be used as a predictor of death in patients with severe COVID-19.
| [1] | Yuan, Y.L., Jiao, B.H., Qu, L.L., Yang, D.M. and Liu, R.J. (2023) The Development of COVID-19 Treatment. Fron-tiers in Immunology, 14, Article 1125246. https://doi.org/10.3389/fimmu.2023.1125246 |
| [2] | 曾向红, 韩彦雄. 中亚五国外交政策调整新动向及其影响[J]. 新疆社会科学, 2023(2): 73-82. |
| [3] | Zhang, J.J., Dong, X., Liu, G.H. and Gao, Y.D. (2023) Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clinical Reviews in Al-lergy & Immunology, 64, 90-107. https://doi.org/10.1007/s12016-022-08921-5 |
| [4] | Zeng, J., Liu, X., Wang, S., et al. (2021) The Association between BMI and Metabolically Unhealthy Status with COVID-19 Mortality: Based on 3019 Inpatients from Wuhan, China. Nutrition, Metabolism and Cardiovascular Diseases, 31, 3219-3226. https://doi.org/10.1016/j.numecd.2021.07.030 |
| [5] | 李磊, 韩晶, 文孝杰. 新冠肺炎长期后遗症的特征及对当前口岸疫情防控工作的思考[J]. 中国国境卫生检疫杂志, 2023, 46(2): 168-170. |
| [6] | 李轩. 新发传染病即时防控的理念选择与制度建构[J]. 行政法学研究, 2023(6): 113-122. |
| [7] | 严易之, 李超亚, 邓曼菲, 等. 基于关键病理生理学过程的网络药理学分析新思路[J]. 中国实验方剂学杂志, 2023, 29(17): 203-211. |
| [8] | 中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版) [J]. 中华临床感染病杂志, 2023, 16(1): 1-9. |
| [9] | Parohan, M., Yaghoubi, S., Seraji, A., et al. (2020) Risk Factors for Mortality in Patients with Coronavirus Disease 2019 (COVID-19) Infection: A Systematic Review and Meta-Analysis of Observational Studies. The Aging Male, 23, 1416-1424. https://doi.org/10.1080/13685538.2020.1774748 |
| [10] | 潘玲, 郭文璟, 郑以州, 等. 成人恶性血液病患者感染omicron突变株的防治策略[J]. 内科急危重症杂志, 2023, 29(2): 89-95. |
| [11] | 车霄, 王乐霄, 赵磊, 等. 重症新型冠状病毒肺炎患者的临床特征及预后风险因素分析[J]. 解放军医学院学报, 2023, 44(2): 101-107. |
| [12] | 陈招进. 糖尿病患者血清APN、Hcy与IL-6水平检测及临床意义[J]. 实用医药杂志, 2016, 33(6): 490-492. |
| [13] | 杨瑞, 张强, 赵亚倩, 等. 炎症因子IL-6、IL-1β与趋化因子CXCR4在氟化钠诱导肝细胞中的表达[J]. 中国地方病防治, 2023, 38(3): 185-188. |
| [14] | Kitsos, D., Tzartos, J., Korres, G., et al. (2023) IL-6 Serum Levels in COVID-19 Patients with Vertigo. Cureus, 15, e35042. https://doi.org/10.7759/cureus.35042 |
| [15] | Higgins, A.M., Berry, L.R., Lorenzi, E., et al. (2023) Long-Term (180-Day) Outcomes in Critically Ill Patients with COVID-19 in the REMAP-CAP Randomized Clinical Trial. Journal of the American Medical Association, 329, 39-51.
https://doi.org/10.1001/jama.2022.23257 |
| [16] | Li, X., Xu, S., Yu, M., et al. (2020) Risk Factors for Severity and Mortality in Adult COVID-19 Inpatients in Wuhan. Journal of Allergy and Clinical Immunology, 146, 110-118. https://doi.org/10.1016/j.jaci.2020.04.006 |
| [17] | 何梅梅, 朱义朗, 尚晓娟, 等. 炎症标志物与新型冠状病毒肺炎患者病情程度关系[J]. 华南预防医学, 2020, 46(3): 247-249, 253. |
| [18] | 唐劲松, 宣春, 林景涛, 等. C-反应蛋白、白介素-6及降钙素原检测在新冠肺炎中的临床意义[J]. 实用医学杂志, 2020, 36(7): 839-841. |
| [19] | 蒋书琴, 汪慧, 刘媛媛, 等. 不同血清白介素-6抑制剂对重症COVID-19患者疗效和安全性的网状Meta分析[J]. 现代预防医学, 2022, 49(19): 3627-3636, 3643. |
| [20] | 游盛俊, 张洪玲, 饶靖红, 等. 术前NLR、CA125及血浆D-二聚体在子宫内膜癌诊断中的临床价值[J]. 中国卫生标准管理, 2022, 13(6): 76-79. |
| [21] | 徐洁, 程尧, 牛飞, 等. 血清癌胚抗原与血浆D-二聚体联合分析对乳腺癌的诊断价值[J]. 中国药物与临床, 2022, 22(5): 411-414. |
| [22] | Eljilany, I. and El-zouki, A.N. (2020) D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review. Vascular Health and Risk Management, 16, 455-462.
https://doi.org/10.2147/VHRM.S280962 |
| [23] | Favaloro, E.J. and Thachil, J. (2020) Reporting of D-Dimer Data in COVID-19: Some Confusion and Potential for Misinformation. Clinical Chemistry and Laboratory Medicine (CCLM), 58, 1191-1199.
https://doi.org/10.1515/cclm-2020-0573 |
| [24] | Rostami, M. and Mansouritorghabeh, H. (2020) D-Dimer Level in COVID-19 Infection: A Systematic Review. Expert Review of Hematology, 13, 1265-1275. https://doi.org/10.1080/17474086.2020.1831383 |
