住院患者死亡的COVID-19危险因素:一项回顾性研究的结果

K. A. Safonova, N. Dekhnich, N. D. Elistratov, E. D. Rzhevtseva, P.G. Filina, A. Kuzmenkov, I. V. Trushin, A. A. Punin
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At the time of admission, the following were taken into account: fever, severity of the patient’s condition according to COVID-19 classification of severity, body mass index (BMI), oxygen saturation (SpO2), percentage of lung tissue damage according to computed tomography (CT). Laboratory indices of biochemical blood analysis were assessed in dynamics: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, total protein, albumin, C-reactive protein (CRP). Data analysis was performed using the R programming language (ver. 4.1.1.). Results. The following risk factors, assessed at the time of hospitalization, increased the likelihood of death: severe and extremely severe condition of the patient (RR = 4.77; 95% CI: 3.33–6.83); SpO2 less than 93% (RR = 3.76; 95% CI: 2.57–5.49); diabetes mellitus (RR = 2.94; 95% CI: 2.01–4.30); lung tissue damage CT-3 and CT-4 (RR = 2.66; 95% CI: 1.79–3.75); concomitant chronic pyelonephritis and chronic kidney disease (CKD) (RR = 2.59; 95% CI: 1.79–3.74); age 65 years and older (RR = 2.50; 95% CI: 1.70–3.67); ischemic heart disease (IHD) (RR = 2.39; 95% CI: 1.42–4.01); an increase in the level of CRP more than 15 mg/l (RR = 2.22; 95% CI: 1.16–4.24); BMI 35 kg/m2 or more (RR = 1.89; 95% CI: 1.28–2.77); AST level more than 2 upper limit of normal (ULN) (RR = 1.75; 95% CI: 1.20–2.55). 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引用次数: 0

摘要

目标。确定冠状病毒感染住院成人患者致命结局和covid -19相关肝损害的危险因素。材料与方法。对389例冠状病毒感染合并双侧病毒性肺炎患者进行回顾性队列研究。对人口学特征、病程的临床特征、记忆资料、实验室和仪器检查结果进行分析,并将其与死亡率联系起来。入院时考虑以下因素:发热、患者病情严重程度(按COVID-19严重程度分类)、体重指数(BMI)、血氧饱和度(SpO2)、计算机断层扫描(CT)肺组织损伤百分比。动态评价血液生化分析实验室指标:谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素、总蛋白、白蛋白、c反应蛋白(CRP)。数据分析使用R编程语言进行。以下4.4.1).Results。住院时评估的以下危险因素增加了死亡的可能性:患者病情严重和极严重(RR = 4.77;95% ci: 3.33-6.83);SpO2 < 93% (RR = 3.76;95% ci: 2.57-5.49);糖尿病(RR = 2.94;95% ci: 2.01-4.30);肺组织损伤CT-3、CT-4 (RR = 2.66);95% ci: 1.79-3.75);合并慢性肾盂肾炎和慢性肾脏疾病(CKD) (RR = 2.59;95% ci: 1.79-3.74);65岁及以上(RR = 2.50;95% ci: 1.70-3.67);缺血性心脏病(IHD) (RR = 2.39;95% ci: 1.42-4.01);CRP升高超过15 mg/l (RR = 2.22);95% ci: 1.16-4.24);BMI≥35 kg/m2 (RR = 1.89;95% ci: 1.28-2.77);AST水平超过正常上限2 (ULN) (RR = 1.75;95% ci: 1.20-2.55)。AST升高大于2 ULN的危险因素为:SpO2 < 93% (RR = 1.53;95% CI: 1.15 - 2.03)、重症和极重症病程(RR = 1.83;95% CI: 1.38-2.43),合并慢性肝病(RR = 1.45, 95% CI: 1.08-1.95)。住院患者致死性COVID-19的危险因素为:患者初始病情严重及极严重、血氧饱和度小于93%、肺组织损伤大于50%、年龄大于65岁、合并糖尿病、慢性肾盂肾炎及冠心病、冠心病、肥胖、CRP升高大于15 mg/l、AST大于70单位/l。AST升高超过2 IU/L可作为COVID-19不良预后的预后实验室指标之一。
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COVID-19 risk factors for mortality in hospitalized patients: results of a retrospective study
Objective. To identify risk factors for fatal outcome and COVID-19-associated liver damage in hospitalized adult patients with coronavirus infection. Materials and Methods. In a retrospective cohort study, 389 cases of patients with coronavirus infection complicated by bilateral viral pneumonia were studied. Demographic characteristics, clinical features of the course of the disease, anamnestic data, results of laboratory and instrumental methods of examination were analyzed and correlated with mortality. At the time of admission, the following were taken into account: fever, severity of the patient’s condition according to COVID-19 classification of severity, body mass index (BMI), oxygen saturation (SpO2), percentage of lung tissue damage according to computed tomography (CT). Laboratory indices of biochemical blood analysis were assessed in dynamics: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, total protein, albumin, C-reactive protein (CRP). Data analysis was performed using the R programming language (ver. 4.1.1.). Results. The following risk factors, assessed at the time of hospitalization, increased the likelihood of death: severe and extremely severe condition of the patient (RR = 4.77; 95% CI: 3.33–6.83); SpO2 less than 93% (RR = 3.76; 95% CI: 2.57–5.49); diabetes mellitus (RR = 2.94; 95% CI: 2.01–4.30); lung tissue damage CT-3 and CT-4 (RR = 2.66; 95% CI: 1.79–3.75); concomitant chronic pyelonephritis and chronic kidney disease (CKD) (RR = 2.59; 95% CI: 1.79–3.74); age 65 years and older (RR = 2.50; 95% CI: 1.70–3.67); ischemic heart disease (IHD) (RR = 2.39; 95% CI: 1.42–4.01); an increase in the level of CRP more than 15 mg/l (RR = 2.22; 95% CI: 1.16–4.24); BMI 35 kg/m2 or more (RR = 1.89; 95% CI: 1.28–2.77); AST level more than 2 upper limit of normal (ULN) (RR = 1.75; 95% CI: 1.20–2.55). Risk factors for an increase in AST more than 2 ULN were: SpO2 less than 93% (RR = 1.53; 95% CI: 1.15– 2.03), severe and extremely severe course of coronavirus infection (RR = 1.83; 95% CI: 1.38–2.43), concomitant chronic liver disease (RR = 1.45, 95% CI: 1.08–1.95). Conclusions. Risk factors for fatal COVID-19 in hospitalized patients are: severe and extremely severe initial condition of the patient, oxygen saturation less than 93%, lung tissue damage more than 50%, age older than 65 years, presence of concomitant diabetes mellitus, chronic pyelonephritis and CHD, CHD, obesity, increased CRP level more than 15 mg/l, and AST more than 70 units/l. Elevation of AST over 2 IU/L can be considered as one of the prognostic laboratory markers of adverse prognosis COVID-19.
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