| 叶婷婷,高宇,张亭亭,梅清,朱春艳.老年重症新型冠状病毒感染的临床特点及影响预后因素分析[J].中国临床保健杂志,2023,26(5):678-682. |
| 老年重症新型冠状病毒感染的临床特点及影响预后因素分析 |
| Analysis of clinical characteristics and prognostic factors of severe COVID-19 in elderly patients |
| 投稿时间：2023-07-26 |
| DOI：10.3969/J.issn.1672-6790.2023.05.022 |
| 中文关键词: 新型冠状病毒感染 体征和症状 预后 危险因素 老年人 |
| 英文关键词: COVID-19 Signs and symptoms Prognosis Risk factors Aged 〖FL |
| 基金项目:安徽省自然科学基金项目(2208085MH236) |
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| 中文摘要: |
| 目的 探讨老年重症新型冠状病毒感染(COVID-19)患者的临床特点及影响患者预后的相关因素。方法 回顾性分析2022年12月至2023年5月中国科学技术大学附属第一医院(安徽省立医院)重症医学科收治的153例老年重症COVID-19患者的临床资料,根据入院28 d转归将患者分为死亡组(72例)和存活组(81例),比较2组患者基本情况、临床表现、入院后实验室检查及并发症。应用多因素logistic回归分析,探寻影响患者预后因素；绘制受试者工作特征曲线(ROC曲线)分析各指标对老年重症COVID-19患者预后的预测价值。结果 与存活组患者比较,死亡组患者危重型占比更高(P<0.001)；死亡组患者意识障碍、心肌损伤、急性心力衰竭、急性肾损伤、脓毒症休克、急性肝损伤、气胸、耐药菌感染的占比高于存活组(P<0.05),而动脉血pH值、氧合指数、淋巴细胞百分比低于存活组(P＜0.05)；血乳酸、C反应蛋白(CRP)、降钙素原、肌钙蛋白、N末端B型钠尿肽前体、D-二聚体、急性生理学和慢性健康状况评估Ⅱ(APACHE Ⅱ)评分死亡组均高于存活组(P＜0.05)。多因素logistic回归分析显示:APACHE Ⅱ评分、氧合指数、CRP是影响老年重症 COVID-19患者预后的独立危险因素(P＜0.05)。评估老年重症COVID-19患者预后的指标中,APACHE Ⅱ评分的曲线下面积(AUC)为0.882,敏感度79.2%,特异度85.2%；氧合指数的AUC为0.774,敏感度88.9%,特异度55.6%；CRP的AUC为0.658,敏感度59.7%,特异度75.3%。结论 老年重症COVID-19死亡组患者的病情较重,易出现多器官功能损伤；入院时APACHE Ⅱ评分、氧合指数、CRP水平是评估老年重症COVID-19患者预后的重要指标。 |
| 英文摘要: |
| Objective To investigate the clinical characteristics and prognostic factors of elderly patients with severe Corona Virus Disease 2019 (COVID-19).Methods The clinical data of 153 elderly patients with severe COVID-19 admitted to the department of intensive care unit,the First Affiliated Hospital of USTC from December,2022 to May,2023 were retrospectively analyzed,the patients were divided into a death group (72 cases) and a survival group (81 cases) based on the 28-day prognosis,the basic situations,clinical manifestations,laboratory examinations after admission and complications were compared between the two groups.Multivariate Logistic regression analysis was used to explore the prognostic factors in elderly patients with severe COVID-19,receiver operating characteristic (ROC) curve was drawn to analyze the prognostic value of each indicator in elderly patients with severe COVID-19.Results Compared with the survival group,the death group had a higher proportion of critical type (P<0.001).The proportion of consciousness disorders,myocardial injury,acute heart failure,acute kidney injury,septic shock,acute liver injury,pneumothorax and drug-resistant bacterial infection in death group was higher than that in survival group (P<0.05).The blood pH,oxygenation index and percentage of lymphocyte in the death group were lower than those in the survival group (P<0.05).Blood lactic acid,C-reactive protein (CRP),procalcitonin,troponin,N-terminal B-type natriuretic peptide precursor,D-dimer,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores in the death group were higher than those in the survival group (P<0.05).Multivariate Logistic regression analysis showed that APACHE Ⅱ score,oxygenation index and CRP were independent risk factors affecting the prognosis of elderly patients with severe COVID-19 (P<0.05).Among the prognostic indicators for elderly patients with severe COVID-19,the area under the curve (AUC) of APACHE Ⅱ score was 0.882,with sensitivity of 79.2% and specificity of 85.2%.The AUC of oxygenation index was 0.774,with the sensitivity was 88.9%,and the specificity was 55.6%.The AUC of CRP was 0.658,with the sensitivity was 59.7% and the specificity was 75.3%.Conclusions The elderly patients in the death group of severe COVID-19 are more seriously ill and prone to multiple organ function damage.APACHE Ⅱ score,oxygenation index and CRP level at admission are important indicators to evaluate the prognosis of elderly patients with severe COVID-19. |
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