年龄和CT评分预测新冠肺炎住院患者的死亡风险:基于A-DROP评分  

Age and Computed Tomography Score to Predict the Risk of Death in COVID-19 Hospitalized Patients:An A-DROP Score Assessment

作　　者：占丰富[1] 曾惠清[1] 黄茂宏[1] 蔡婧凰 胡兰 明泉 张孝斌[1] ZHAN Fengfu;ZENG Huiqing;HUANG Maohong;CAI Jinghuang;HU Lan;MING Quan;ZHANG Xiaobin(Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Xiamen University,Fujian Xiamen 361004,China;Department of Gastroenterology,Optic Valley Division of Tongji Hospital,Huazhong University of Science and Technology,Hubei Wuhan 430030,China;Yichang Third People′s Hospital,Affiliated to Sanxia University,Hubei Yichang 443008,China)

机构地区：[1]厦门大学附属中山医院呼吸与危重症医学科,福建厦门361004 [2]华中科技大学附属同济医院光谷院区消化内科,湖北武汉430030 [3]三峡大学附属宜昌市第三人民医院,湖北宜昌443008

出　　处：《中国医药导刊》2022年第4期366-374,共9页Chinese Journal of Medicinal Guide

基　　金：国家自然科学基金项目(项目编号:82170103;项目名称:基于HIF-1a/BNIP3通路探讨肾小管上皮细胞线粒体自噬在间歇低氧肾损害中的作用机制);福建省卫生健康科技计划中青年骨干人才培养项目(项目编号:2020GGB057;项目名称:间歇缺氧通过miR-210介导E2F3基因表达促进肿瘤进展的机制研究);厦门市科技局卫生指导性项目(项目编号:3502Z20214ZD1043;项目名称:基于miR-138/HIF-1a/VEGF通路探讨丹参酮IIA对间歇低氧小鼠肿瘤生物学行为的作用机制)。

摘　　要：目的:探索研究新冠肺炎住院患者高死亡风险的独立预测因素,旨在区分可能需要加强监护治疗患者,助力新冠肺炎疫情防控。方法:回顾性分析湖北省2家医院确诊为新冠肺炎的302例患者的临床资料。基于A-DROP评分系统(年龄:男性≥70岁,女性≥75岁;脱水表现或血尿素氮≥21 mg·dL^(-1);血氧饱和度≤90%或动脉血氧分压≤60 mmHg;意识障碍;收缩压≤90 mmHg),将患者分为低风险组(A-DROP评分=0)和高风险组(A-DROP评分≥1)。使用多元逻辑回归分析来阐明新冠肺炎住院患者高死亡风险的独立预测因素。结果:高风险组住院患者67例(22.19%),低风险组住院患者235例(77.81%)。高风险组患者的年龄和CT评分较低风险组更高,死亡率显著高于低风险组。根据受试者工作特征曲线,当患者的年龄≥68岁,入院时CT评分≥8时,住院死亡风险较高。多元逻辑回归分析显示,年龄≥68岁(OR为25.31,95%CI:8.99~71.27,P<0.001)和CT评分≥8(OR为2.69,95%CI:1.01~7.21,P=0.048)是新冠肺炎住院患者高死亡风险的独立预测因素。结论:高龄和高CT评分是新冠肺炎住院患者高死亡风险的独立预测因素。Objective:To explore independent predictors of the high death risk in corona virus disease-2019(COVID-19)hospitalized patients,so as to distinguish patients at high risk of death who may require strengthening monitoring and treatment,to help the prevention and control of the COVID-19 epidemic.Methods:The clinical data of 302 patients diagnosed COVID-19 in two hospitals in Hubei province of China were retrospectively analyzed in this study.We assigned patients into two groups(low-risk group:A-DROP score=0,high-risk group:A-DROP score≥1)based on the A-DROP(Age:Male≥70 years old,Female≥75 years old;Dehydration:BUN≥21 mg·dL^(-1) or dehydration(+);Respiratory:SpO 2≤90%or PaO 2≤60 mmHg;Confusion;Systolic blood pressure≤90 mmHg)score system.We used multivariate logistic regression analysis to clarify the independent predictors of high death risk in COVID-19 hospitalized patients.Results:The high-risk group included 67 patients(22.19%),while the low-risk group included 235 patients(77.81%).The age and computed tomography(CT)score of the high-risk group was higher and had a significantly higher mortality rate than the low-risk group.According to the receiver operator characteristic(ROC)curve,when age≥68 years old,CT score≥8 on admission,the patients had a higher in-hospital mortality rate.Multivariate logistic regression analysis revealed that age≥68 years old(OR:25.31,95%CI:8.99~71.27,P<0.001)and CT score≥8(OR:2.69,95%CI:1.01~7.21,P=0.048)were independent predictors of high death risk in COVID-19 hospitalized patients.Conclusion:Older age and high CT score were independent predictors of high risk of death in COVID-19 hospitalized patients.

关 键 词：年龄 CT评分 新冠肺炎 A-DROP评分 

分 类 号：R373.1[医药卫生—病原生物学]