新冠肺炎住院患者危重症的危险因素分析及危重症预测  

Analysis of risk factors and prediction of critical illness of COVID-19 inpatients

作　　者：王小曼 程瑞 柯晶耀 咸宏飞 吴斌 李静宜 陈泳森 吴一帆 韩梦琦 贾伟杰 俞鹏飞 罗颢文 刘建模 刘松 易应萍[1] WANG Xiao-man;CHENG Rui;KE Jing-yao;XIAN Hong-fei;WU Bin;LI Jing-yi;CHEN Yong-sen;WU Yi-fan(Big Data Research Center of the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330006,China;不详)

机构地区：[1]南昌大学第二附属医院医疗大数据研究中心,江西南昌330006 [2]南昌大学公共卫生学院,江西省预防医学重点实验室,江西南昌330006 [3]南昌大学第二附属医院科技处

出　　处：《现代预防医学》2023年第21期4015-4020,4032,共7页Modern Preventive Medicine

基　　金：科技部国家重点研发计划(2020YFC2002901);国家自然科学基金地区科学基金项目(81960609);江西省重点研发计划重点项目(20223BBH80013);江西省应用研究培育计划(20212BAG70029);南昌大学第二附属医院院内资助项目(2021efy B03)。

摘　　要：目的 回顾性探讨新冠住院患者危重症的相关危险因素并进行危重症预测。方法 收集2022年11月—2023年1月某三甲医院收治的新冠住院2 745例患者的临床资料,根据住院结局分组。通过单因素分析和多因素logistic回归分析明确危险因素,并通过受试者工作特征(ROC)曲线下面积(AUC)、训练集和验证集的校准曲线、训练模型和验证模型的决策曲线分析(DCA曲线)等评价联合因素对新冠住院患者预后结局的预测价值。结果 经单因素和多因素logistic回归分析结果显示年龄(OR=1.05,95%CI:1.03~1.06)、手术(OR=8.81,95%CI:5.64~13.76)、预后营养指数(PNI)(OR=0.92,95%CI:0.89~0.96)、淋巴细胞绝对值(OR=0.47,95%CI:0.26~0.83)、胸腔积液(OR=0.49,95%CI:0.28~0.86)等与新冠住院危重症相关(P<0.05)。ROC曲线下面积显示几项指标联合预测AUC值为0.924。结论 发现高龄、中性粒细胞绝对值高、红细胞压积低、乳酸脱氢酶高、手术、营养状况差、血红蛋白低、血小板计数低、淋巴细胞绝对值低、有胸腔积液可能是造成新冠住院患者危重症的危险因素,且联合几项指标有良好的预测价值。对危险因素早期识别并采取积极有效的措施,有助于预防新冠危重症的发生。Objective To retrospectively investigate the related risk factors of critical illness in COVID-19 inpatients and predict the critical illness.Methods The clinical data of 2745 inpatients of COVID-19 treated in a tertiary hospital from November 2022 to January 2023 were collected and divided into two groups according to the outcome of hospitalization.The risk factors were identified by univariate analysis and multivariate Logistic regression analysis,and the predictive value of combined factors on the prognosis of COVID-19 inpatients was evaluated by the area under the receiver operator characteristic(ROC)curve(AUC),the calibration curve of training set and verification set,and the decision curve analysis(DCA)of training model and verification model.Results The results of univariate and multivariate Logistic regression analysis showed that age(OR=1.05,95%CI:1.03-1.06),operation(OR=8.81,95%CI:5.64-13.76),prognostic nutrition index(PNI)(OR=0.92,95%CI:0.89-0.96),absolute value of lymphocytes(OR=0.47,95%CI:0.26-0.83),and pleural effusion(OR=0.49,95%Cl:0.28-0.86)were associated with critical illness of COVID-19 in hospital.The area under the ROC curve showed that the AUC value predicted by several indexes was 0.924.Conclusion Advanced age,high absolute value of neutrophils,low hematocrit,high lactate dehydrogenase,operation,poor nutritional status,low hemoglobin,low platelet count,low absolute value of lymphocytes,and pleural effusion may be the risk factors of critical illness in COVID-19 inpatients,and the combination of several indexes has good predictive value.Early identification of risk factors and taking positive and effective measures are helpful to prevent the occurrence of COVID-19 critical illness.

关 键 词：新冠肺炎 住院患者 危重症 危险因素 危重症预测 

分 类 号：R563.1[医药卫生—呼吸系统]