113例新冠病毒確診逝者臨床特徵的回顧性研究
作者：
小柯機器人發布時間：2020/3/28 21:46:59
華中科技大學附屬同濟醫院寧琴課題組，對113例新冠病毒確診逝者的臨床特徵進行了回顧性分析。相關論文於2020年3月26日發表在《英國醫學雜誌》上。
為了描述2019冠狀病毒病（covid-19）逝者的臨床特徵，研究組對武漢同濟醫院收治的799例患者進行了一項回顧性研究，數據收集至2020年2月28日。
在這799例確診covid-19的患者中，113例死亡，161例康復。113例逝者的中位年齡為68歲，顯著大於康復者（51歲）。逝者中男性佔73%，顯著高於康復者（55%）。逝者中慢性高血壓和其他心血管合併症分別佔48%和14%，顯著高於康復者（24%和4%）。
逝者中呼吸困難、胸悶和意識障礙的發生率分別為62%、49%和22%，均顯著高於康復者（31%、30%和1%）。逝者從疾病發作到死亡的中位時間為16天。逝者中白細胞增多和淋巴細胞減少患者所佔比率分別為50%和91%，均顯著高於康復者（4%和47%）。
逝者的丙氨酸氨基轉移酶、天冬氨酸氨基轉移酶、肌酐、肌酸激酶、乳酸脫氫酶、心肌肌鈣蛋白I、N端腦鈉肽和D-二聚體的水平顯著高於康復患者。逝者中觀察到的常見併發症包括急性呼吸窘迫症候群（100%）、I型呼吸衰竭（51%）、敗血症（100%）、急性心臟損傷（77%）、心力衰竭（49%）、鹼中毒（40%）、高鉀血症（37%）、急性腎損傷（25%）和低氧性腦病（20%）。
伴有心血管合併症的患者更容易出現心臟併發症。無論心血管疾病的病史如何，逝者中急性心臟損傷和心力衰竭更為常見。
總之，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礙。急性呼吸窘迫症候群和呼吸衰竭、敗血症、急性心臟損傷和心力衰竭是covid-19惡化期間最常見的主要併發症。
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