法國最新研究：新冠肺炎患者死亡率和入住ICU預測因素及其肺外併發症

文獻來源

https://www.sciencedirect.com/science/article/pii/S2666991921004255

背景與目的

法國東北地區在2020年春季爆發了較大的新冠肺炎疫情。本項單中心、回顧性、觀察性的佇列研究旨在對該地區的重型和非重型新冠肺炎患者（存活患者和死亡患者、入住和非入住ICU患者）進行對比分析，並對患者的肺外併發症進行描述性分析。

研究物件與方法

研究物件為在2020年3月因為確診新冠肺炎入住科爾馬醫院的所有患者。

結果

共納入600例患者（中位年齡：71.09歲；中位體質量指數：26.9 kg/m2），其中57.7%的患者為男性，86.3%的患者至少患有一種共病；153(25.5%)例患者需要入住ICU進行治療，115（19.1%）例患者死亡。與患者死亡獨立相關的基線因素包括：高齡[>75歲（本研究中低齡定義為≤75 歲)], 男性、氧氣供應情況、慢性神經疾病、慢性腎病、慢性肺病、糖尿病，癌症、血小板和血紅蛋白計數低、C-反應蛋白和血清肌酐水平高。與患者入住ICU相關的因素有<75歲、氧氣供應情況、慢性肺病、非痴呆、高 C-反應蛋白、高血紅蛋白和高血清肌酐。600例患者中，有80例（13.3%）發生了急性腎損傷，33例（5.5%）發生了心血管事件，27例（4.5%）發生了急性肝損傷，24例（4%）發生了靜脈血栓栓塞，8例（1.3%）發生了神經系統不良事件，5例（0.8%）發生了橫紋肌溶解，1例發生了急性胰腺炎。大多數肺外併發症發生在入住ICU的患者中。

結論

本項在法國開展的研究揭示了導致重症新冠肺炎患者入住ICU和死亡的主要危險因素並分析了新冠肺炎患者多種肺外併發症的發生率。

Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients

Objective

A major coronavirus disease 2019 (COVID-19) outbreak occurred in Northeastern France in spring 2020. This single-center retrospective observational cohort study aimed to compare patients with severe COVID-19 and those with non-severe COVID-19 (survivors vs. non-survivors, ICU patients vs. non-ICU patients) and to describe extrapulmonary complications.

Patients and methods

We included all patients with a confirmed diagnosis of COVID-19 admitted to Colmar Hospital in March 2020.

Result

We examined 600 patients (median age 71.09 years; median body mass index: 26.9 kg/m2); 57.7% were males, 86.3% had at least one comorbidity, 153 (25.5%) required ICU hospitalization, and 115 (19.1%) died. Baseline independent factors associated with death were older age (> 75 vs. ≤ 75 years), male sex, oxygen supply, chronic neurological, renal, and pulmonary diseases, diabetes, cancer, low platelet and hemoglobin counts, and high levels of C-reactive protein (CRP) and serum creatinine. Factors associated with ICU hospitalization were age < 75 years, oxygen supply, chronic pulmonary disease, absence of dementia, and high levels of CRP, hemoglobin, and serum creatinine. Among the 600 patients, 80 (13.3%) had an acute renal injury, 33 (5.5%) had a cardiovascular event, 27 (4.5%) had an acute liver injury, 24 (4%) had venous thromboembolism, eight (1.3%) had a neurological event, five (0.8%) had rhabdomyolysis, and one had acute pancreatitis. Most extrapulmonary complications occurred in ICU patients.

Conclusion

This study highlighted the main risk factors for ICU hospitalization and death caused by severe COVID-19 and the frequency of numerous extrapulmonary complications in France.

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