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113例新冠病毒确诊逝者临床特征的回顾性研究
作者:小柯机器人 发布时间:2020/3/28 21:46:59

华中科技大学附属同济医院宁琴课题组,对113例新冠病毒确诊逝者的临床特征进行了回顾性分析。相关论文于2020年3月26日发表在《英国医学杂志》上。

为了描述2019冠状病毒病(covid-19)逝者的临床特征,研究组对武汉同济医院收治的799例患者进行了一项回顾性研究,数据收集至2020年2月28日。

在这799例确诊covid-19的患者中,113例死亡,161例康复。113例逝者的中位年龄为68岁,显著大于康复者(51岁)。逝者中男性占73%,显著高于康复者(55%)。逝者中慢性高血压和其他心血管合并症分别占48%和14%,显著高于康复者(24%和4%)。

逝者中呼吸困难、胸闷和意识障碍的发生率分别为62%、49%和22%,均显著高于康复者(31%、30%和1%)。逝者从疾病发作到死亡的中位时间为16天。逝者中白细胞增多和淋巴细胞减少患者所占比率分别为50%和91%,均显著高于康复者(4%和47%)。

逝者的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、肌酸激酶、乳酸脱氢酶、心肌肌钙蛋白I、N端脑钠肽和D-二聚体的水平显著高于康复患者。逝者中观察到的常见并发症包括急性呼吸窘迫综合征(100%)、I型呼吸衰竭(51%)、败血症(100%)、急性心脏损伤(77%)、心力衰竭(49%)、碱中毒(40%)、高钾血症(37%)、急性肾损伤(25%)和低氧性脑病(20%)。

伴有心血管合并症的患者更容易出现心脏并发症。无论心血管疾病的病史如何,逝者中急性心脏损伤和心力衰竭更为常见。

总之,新冠病毒感染可引起肺部和全身炎症,造成高危患者多器官功能障碍。急性呼吸窘迫综合征和呼吸衰竭、败血症、急性心脏损伤和心力衰竭是covid-19恶化期间最常见的主要并发症。

附:英文原文

Title: Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study

Author: Tao Chen, Di Wu, Huilong Chen, Weiming Yan, Danlei Yang, Guang Chen, Ke Ma, Dong Xu, Haijing Yu, Hongwu Wang, Tao Wang, Wei Guo, Jia Chen, Chen Ding, Xiaoping Zhang, Jiaquan Huang, Meifang Han, Shusheng Li, Xiaoping Luo, Jianping Zhao, Qin Ning

Issue&Volume: 2020/03/26

Abstract: Abstract

Objective To delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.

Design Retrospective case series.

Setting Tongji Hospital in Wuhan, China.

Participants Among a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.

Main outcome measures Clinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms.

Results The median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.

Conclusion Severe acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

DOI: 10.1136/bmj.m1091

Source: https://www.bmj.com/content/368/bmj.m1091

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj