重症新型冠状病毒肺炎患者的死亡风险因素分析

Analysis of the Risk Factors of Mortality in Patients with Severe COVID-19

摘要: 目的：分析重症新型冠状病毒肺炎患者的死亡风险因素。方法：本研究为一项回顾性病例对照研究。连续性收集2022年10月至2023年4月西京医院、空军第九八六医院确诊为重症新冠肺炎的患者，按生存结局将患者分为死亡组(90例)和对照组(277例)，分析其生存情况及预后影响因素。生存资料采用logistic回归和Kaplan-Meier法进行分析。结果：单因素分析结果显示：分型、脉搏、呼吸频率、白介素-6、降钙素原、中性粒细胞计数、淋巴细胞计数、血小板计数、活化部分凝血活酶时间、D-二聚体、谷丙转氨酶、谷草转氨酶、总胆红素、胱抑素C、肌酐、乳酸脱氢酶与早期死亡显著相关(P < 0.05)。多因素Logistic回归分析结果显示：分型、脉搏、白介素-6、D-二聚体、总胆红素、胱抑素C是重症新冠患者住院死亡的独立危险因素。Kaplan-Meier生存分析显示：患者诊断为危重型、白介素-6 ≥ 135.4 pg/ml、D-二聚体 ≥ 9.175 mg/L时，生存时间显著缩短。结论：危重型、白介素-6 ≥ 135.4 pg/ml、D-二聚体 ≥ 9.175 mg/L与重症新型冠状病毒肺炎的高死亡风险有关，可作为重症新型冠状病毒肺炎患者的死亡预测指标。

Abstract: Objective: To analyze the risk factors of mortality in patients with severe COVID-19. Methods: This study is a retrospective case-control study. The patients who were diagnosed as severe COVID-19 in Xijing Hospital and Air Force 986 Hospital from October 2022 to April 2023 were continuously col-lected, were divided into death group (n = 90) and control group (n = 277) by the survival outcome, then analyzing the survival and prognostic factors. Survival data were analyzed by logistic regres-sion and Kaplan-Meier method. Results: Univariate analysis showed that type, P, R, IL-6, PCT, N, L, PLT, APTT, D-dimer, ALT, AST, TBIL, CysC, CRE, LDH are significantly correlated with early death (P < 0.05). Multivariate Logistic regression analysis showed that type, P, IL-6, D-dimer, TBIL and CysC were independent risk factors for hospitalized death in severe COVID-19 patients. Kaplan-Meier survival analysis showed that the survival time was significantly shortened when the patients were diagnosed as critical type of COVID-19, IL-6 ≥ 135.4 pg/ml and D-dimer ≥ 9.175 mg/L. Conclusion: Critical type, IL-6 ≥ 135.4 pg/ml and D-dimer ≥ 9.175 mg/L are related to the high risk of death of severe COVID-19, which can be used as a predictor of death in patients with severe COVID-19.