摘要
目的倾向性评分匹配(propensity score matching analysis,PSM)分析新型冠状病毒肺炎危重症患者的影响因素。方法连续选取2020年1月27日至2020年3月18日于武汉市第三医院就诊的新型冠状病毒肺炎(COVID-19)患者共292例。根据临床分型分为两组:普通型(包括轻症)组和危重型(包括重型)组,经PSM 1∶2后普通型(包括轻症)组101例,危重型(包括重型)组64例。通过电子病历系统收集患者入院的临床基线资料和心电图资料。采用Cox回归模型分析COVID-19患者发生危重症的危险指标,以及危重症患者死亡的影响因素。结果 (1)PSM前两组患者的年龄、性别比、高血压病、冠心病史以及合并≥2种心血管系统疾病比率差异有统计学意义(P<0.05),但PSM后两组患者的年龄、性别比、心血管系统疾病史差异均无统计学意义(P>0.05);PSM前两组患者的白细胞计数和淋巴细胞计数差异有统计学意义(P <0.05),PSM后仅白细胞计数差异有统计学意义(P<0.05);PSM前后观察组患者的CRP升高,血钙降低,病死率高,差异均有统计学意义(P<0.05)。(2)PSM前两组患者的心电图改变在早搏、ST段凹面型上抬以及全导联T波低平改变方面差异有统计学意义(P<0.05),但PSM后仅ST段凹面型上抬改变差异有统计学意义(P<0.05)。(3)COVID-19危重症患者危险指标的Cox回归分析显示:在校正了年龄、性别、淋巴细胞计数、超敏肌钙蛋白I(hs-TNI)、血钙混杂因素后,SpO2、白细胞计数和CRP是COVID-19患者发生危重症的影响因素,OR值分别为:1.059(95%CI:1.003~1.119,P<0.05)、0.938(95%CI:0.921~0.955,P<0.05)、1.004(95%CI:1.001~1.007);ST段凹面型上抬不是COVID-19患者发生危重症的危险指标,而是COVID-19危重症患者死亡的预测指标,OR值为3.095(95%CI:1.657~5.782,P<0.05)。结论经倾向性匹配分析,入院SPO2降低,CRP、白细胞计数升高,是COVID-19患者发生危重症的影响因素,除年龄大、SPO2降低外,ST段凹面型上抬是危重型COVID-19患者死亡的影响因素。
Objective To explore the high risk factors associated with severe and critical patients with coronavirus disease-2019(COVID-19)by propensity score matching analysis(PSM),and to improve the ability of the early recognition and intervention,and thus to realize higher survival rate of these patients.Methods 292 patients with laboratory confirmed COVID-19 admitted to the Third Hospital of Wuhan from January 27,2020 to March 18,2020 were selected.According to the symptoms,the patients were divided into two groups:213 mild/moderate patients and 79 severe/critical patients.By PSM,a total of 165 cases were included,of which 101 were mild/moderate patients and 65 were severe/critical patients.Baseline characteristics,laboratory findings,clinical outcome and ECG data of these patients were collected,and the risk factors of severe/critical patients with COVID-19 and their outcome were explored by using a COX model.Results Before PSM,The difference of age,sex,hypertension,coronary heart disease history and the ratio of cardiovascular diseases with or less than 2 types of cardiovascular system was statistically significant between the two groups.However,after PSM,there were no significant differences(P>0.05).There were significant differences in WBC count and lymphocyte count between the two groups before PSM(P<0.05),while only WBC count after PSM was statistically significant(P<0.05).CRP increased,blood calcium decreased and mortality was high in observation group before and after PSM,and the differences were statistically significant(P<0.05).There were significant differences in ECG changes between the two groups before PSM in premature beat,concave ST segment elevation and T wave depression(P<0.05),but only the concave ST segment elevation after PSM was statistically significant(P<0.05).Cox regression analysis showed that SpO2,WBC count and CRP were risk factors of severe/critical COVID-19 patients after adjusting for age,gender,lymphocyte count,hs-TnI and blood calcium,the odds ratios(OR)were respectively 1.059(95%CI:1.003~1.119,P<0.05),0.938(95%CI:0.921~0.955,P<0.05),1.004(95%CI:1.001~1.007,P<0.05).Concave ST segment elevation was not a risk factor for severe covid-19 patients,but an independent risk factor for death in COVID-19 patients,OR was 3.095(95%CI:1.657~5.782,P<0.05).Conclusion According to propensity matching analysis,decreased SpO2,increased white blood cell count and CRP were risk factors for severe covid-19patients.In addition to older age and decreased SpO2,concave ST segment elevation was an independent risk factor for death in severe/critical COVID-19 patients.
作者
李晴
LI Qing(Department of Cardiac-pulmonary Function,Third Hospital of Wuhan,Wuhan Hubei 430060,China)
出处
《实用医学杂志》
CAS
北大核心
2021年第13期1655-1659,共5页
The Journal of Practical Medicine
基金
武汉市卫生健康委员会项目(编号:EX20E10)。
