老年新型冠状病毒肺炎患者凝血功能紊乱与预后的回顾性分析  

Retrospective investigation of the relationship of coagulant dysfunction with death in elderly patients with coronavirus disease-19 pneumonia

作　　者：高伟[1] 范正阳 郝国云 孙麓[2] 谢江[1] GAO Wei;FAN Zhengyang;HAO Guoyun;SUN Lu;XIE Jiang(Department of Respiratory and Critical Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸与危重症医学科,100029 [2]华中科技大学同济医学院附属协和医院西院神经内科

出　　处：《心肺血管病杂志》2020年第7期753-756,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:调查老年新型冠状病毒肺炎(COVID-19)患者凝血功能异常对预后的影响。方法:回顾性分析2020年1月28日至2月28日,于武汉协和医院西院收治的62例≥60岁的普通型、重型、危重型COVID-19患者。记录截止3月12日患者出院(存活)或死亡的信息。届时仍未出院但病情的稳定的患者视为存活。分析患者入院化验PLT和D-Dimer结果与住院期间预后的相关性。结果:全部患者中位随访时间为13 d;共死亡26例(41.9%)。男性死亡17例(60.7%),女性死亡9例(26.5%)。PLT<15×10^9/L的患者比血小板正常的患者死亡率显著偏高(56.0%vs.32.4%,χ^2=4.87,P=0.027)。与之相似,D-Dimer≥14μg/mL的患者死亡率高于对照人群(47.1%vs.6.3%,χ^2=5.87,P=0.015)。多元COX模型分析显示PLT降低患者是对照人群死亡风险的2.31倍(RR=2.31,95%CI:1.06~5.10,P=0.035),D-Dimer高于1.4μg/mL的患者是其血清水平正常患者死亡风险的8.51倍(RR=8.51,95%CI:1.56~157.88,P=0.010)。在矫正年龄、性别后,D-Dimer升高仍旧是死亡的危险因素(RR=9.01,95%CI:1.60~169.85,P=0.009)。结论:凝血功能紊乱可能是老年COVID-19患者死亡的原因。Objective:To unveil the prognostic effect of coagulant dysfunction on patients with coronavirus disease-19(COVID-19)associated pneumonia.Methods:Retrospective investigation of patients(age≥60 years)treated in West Hospital,Wuhan Union Hospital from January 28th,2020 to February 28th,2020.Patients’information of discharge or death were recorded on March 12th,whichever occurred first.Patients who were still hospitalized and stable on the last follow-up day were regarded to be alive.The association of coagulant dysfunction evaluated by D-Dimer and platelet with death were calculated.Results:Patients had a median of 13-day in-hospital duration,and 26(41.9%)patients died,including 17(60.7%)male and 9(26.5%)female.Patients with decreased platelet of<15×109/L had significantly higher risk of death than those with normal value(56.0%vs.32.4%,χ^2=4.87,P=0.027).Similarly,compared with those with normal level of D-Dimer,patients with elevated level of D-Dimer had more deceased cases(47.1%vs.6.3%,χ^2=5.87,P=0.015).Both Platelet decrement and D-Dimer increment were associated with higher risk of death compared with those with normal range of platelet(RR=2.31,95%CI:1.06-5.10,P=0.035)and D-Dimer(RR=2.31,95%CI:1.06-5.10,P=0.035)respectively,with the prognostic value of D-Dimer persisting after adjusting for age and sex(RR=9.01,95%CI:1.60-169.85,P=0.009).Conclusions:Coagulant dysfunction might be a predictor of death for elderly patients with COVID-19 associated pneumonia.

关 键 词：新型冠状病毒肺炎 凝血紊乱 预后 

分 类 号：R56[医药卫生—呼吸系统]