乌克兰第三波COVID-19期间需要住院治疗的患者冠状病毒病的临床和实验室特征以及致命结果的危险因素:一项单中心回顾性研究

Т. Pertseva, K. Gashynova, V. V. Rudakova, V. V. Rodionova, V. Dmytrychenko, O. Kovalenko, O. V. Kravets, N. O. But, N. V. Laksha, L. A. Hlyniana, O. F. Mykhailenko, S. P. Novikov
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By that time, it had already been established that clinical characteristics of patients and levels of inflammatory markers differed between Delta and non-Delta variants. The aim of the study was to analyze the anthropometric, clinical, anamnestic and laboratory characteristics of patients with COVID-19 who required hospitalization during the third wave of the epidemic in Ukraine, in order to determine the risk predictors of fatal outcome. Materials and methods. The study was a single-center retrospective analysis conducted on an original cohort of 632 patients who were admitted with confirmed COVID-19 to Public Non-profit Organization “City Clinical Hospital № 4” Dnipro City Council during August-October 2021. The following data were obtained and analyzed from the medical records of the studied patients: degree of severity at the time of admission according to the COVID-19 Severity Index, demographic characteristics, comorbidity, presentation, vital signs and laboratory parameters at admission, results of chest computed tomography, treatment options and the outcomes. Results. The patients’ median age was 63 years, 38,8 % were male. Hospital mortality rate was 23,58%. The median of bed count days — 9 [6, 12]. Fever (76,3 %), dyspnea (85,4 %), cough (53,3 %) and fatigue (49,5 %) were the most common clinical manifestations on admission. The percentage of patients with comorbidities was significantly higher among deceased (96,0 % vs. 56,1 %). The most prevalent were cardio- and neurometabolic comorbidities. The median SpO2 on admission was significantly lower among deceased — 86 [75, 90]. There were 25,44 % and 57,23 % of all hospitalized patients who received ICU care and oxygen therapy, respectively. The regression analysis revealed the age older than 57 years (HR 3,198, 95 % CI 1,992–5,134), neuromuscular symptoms (HR 2,033, 95 % CI 1,358–3,045) and chest pain (HR 1,867, 95 % CI 1,055–3,306), the presence of co-morbidity (HR 26,678, 95% CI 8,498–83,750), primarily arterial hypertension (HR 3,945, 95 % CI 2,725–5,712), coronary heart disease (HR 7,619, 95% CI 5,155–11,259), heart failure (HR 2,823, 95% CI 2,020–3,944), diabetes (HR 2,966, 95 % CI 2,095–4,200), arrhythmia (HR 2,247, 95 % CI 1,524–3,312), cerebrovascular diseases (HR 2,746, 95% CI 1,725–4,372) were reliable predictors of fatal outcome in COVID-19. At the same time, after conducting the regression analysis of initial laboratory parameters, the additional prognostic risk factors were revealed: lymphocyte level ≤ 0,66 (HR 1,81, 95 % CI 1,19–2,76), AST > 50,2 (HR 1,86, 95 % CI 1,15–3,02), total protein ≤ 66,1 (HR 1,55, 95% CI 1,02-2,36), creatinine > 102,7 (HR 2,57, 95 % CI 1,51–4,34), urea > 7,54 (HR 2,30, 95 % CI 1,41–3,75), CRP > 46,8 (HR 4,37, 95 % CI 2,48–7,68). Conclusion. The third wave of the coronavirus disease pandemic in Ukraine is characterized by a larger number of patients with a severe course and a lower level of blood oxygenation upon admission; accordingly, a more significant number of patients requiring oxygen support (57,23 %), treatment in the intensive care unit (25,44 %) and a higher mortality rate (23,58 %). For the timely identification of a high-risk group of patients with COVID-19 with the purpose of targeted monitoring and early change or intensification of treatment tactics, the following potential risk factors were determined: age > 57 years, presence of chest pain, and neuromuscular symptoms on admission to the hospital, more than 2 comorbidities, primarily, arterial hypertension, diabetes, cerebrovascular diseases, coronary heart disease, heart failure, and arrhythmia, as well as some laboratory indicators: lymphocyte level ≤ 0,66; AST > 50,2; total protein ≤ 66,1; creatinine > 102,7; urea > 7,54; CRP > 46,8. Key words: COVID-19, hospitalized patients, risk factors for lethal outcome Ukr. Pulmonol. 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Novikov\",\"doi\":\"10.31215/2306-4927-2022-30-4-6-18\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"CLINICAL AND LABORATORY FEATURES OF CORONAVIRUS DISEASE AND RISK FACTORS OF LETHAL OUTCOME IN PATIENTS WHO REQUIRED HOSPITALIZATION DURING THE THIRD WAVE OF COVID-19 IN UKRAINE: A SINGLE-CENTER RETROSPECTIVE STUDY Т. О. Pertseva, K. Y. Gashynova, V. V. Rudakova, V. V. Rodionova, V. V. Dmytrychenko, O. Y. Kovalenko, O. V. Kravets, N. O. But, N. V. Laksha, L. A. Hlyniana, O. F. Mykhailenko, S. P. Novikov Abstract August 2021 in Ukraine marked the beginning of the third wave of COVID-19, catastrophic in terms of hospitalization and mortality, when, according to the Ministry of Health, the Delta strain was the dominant variant of the virus. By that time, it had already been established that clinical characteristics of patients and levels of inflammatory markers differed between Delta and non-Delta variants. 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引用次数: 0

摘要

乌克兰第三波COVID-19期间需要住院治疗的患者冠状病毒病的临床和实验室特征以及致命结果的危险因素:一项单中心回顾性研究Т。О。Pertseva, K. Y. Gashynova, V. V. Rudakova, V. V. Rodionova, V. V. Dmytrychenko, O. Y. Kovalenko, O. V. Kravets, N. O. But, N. V. Laksha, L. A. Hlyniana, O. F. Mykhailenko, S. P. Novikov摘要2021年8月在乌克兰标志着第三波COVID-19的开始,在住院和死亡率方面都是灾难性的,根据卫生部的说法,Delta毒株是该病毒的主要变体。到那时,已经确定患者的临床特征和炎症标志物水平在Delta和非Delta变体之间存在差异。该研究的目的是分析在乌克兰第三波疫情期间需要住院治疗的COVID-19患者的人体测量学、临床、记忆和实验室特征,以确定致命结果的风险预测因素。材料和方法。该研究是一项单中心回顾性分析,对2021年8月至10月期间在公共非营利组织“第4市临床医院”第聂伯罗市议会接受确诊COVID-19的632名原始队列患者进行了分析。从研究患者的病历中获取并分析以下数据:根据COVID-19严重程度指数入院时的严重程度、人口学特征、合并症、表现、入院时的生命体征和实验室参数、胸部计算机断层扫描结果、治疗方案和结局。结果。患者中位年龄63岁,男性38.8%。医院死亡率为23.58%。床数天数中位数- 9[6,12]。入院时最常见的临床表现为发热(76.3%)、呼吸困难(85.4%)、咳嗽(53.3%)和疲劳(49.5%)。死者中有合并症的患者比例明显更高(96.0% vs. 56.1%)。最常见的是心脏和神经代谢合并症。入院时的SpO2中位数在死者中显著低于86[75,90]。接受ICU护理和氧疗的住院患者分别占25.44%和57.23%。回归分析显示年龄大于57岁(HR 3,198, 95% CI 1,992-5,134),神经肌肉症状(HR 2,033, 95% CI 1,358-3,045)和胸痛(HR 1,867, 95% CI 1,055-3,306),合并发病(HR 26,678, 95% CI 8,498-83,750),主要是动脉高血压(HR 3,945, 95% CI 2,725-5,712),冠心病(HR 7,619, 95% CI 5,155-11,259),心力衰竭(HR 2,823, 95% CI 2,095 - 3,944),糖尿病(HR 2,966, 95% CI 2,095-4,200),心律失常(HR 2,247,95% CI 1,524-3,312)、脑血管疾病(HR 2,746, 95% CI 1,725-4,372)是COVID-19致命结局的可靠预测因素。同时,通过对初始实验室参数进行回归分析,揭示了其他预后危险因素:淋巴细胞水平≤0,66 (HR 1,81, 95% CI 1,19 - 2,76), AST > 50,2 (HR 1,86, 95% CI 1,15 - 3,02),总蛋白≤66,1 (HR 1,55, 95% CI 1,02-2,36),肌酐> 102,7 (HR 2,57, 95% CI 1,51 - 4,34),尿素> 7,54 (HR 2,30, 95% CI 1,41 - 3,75), CRP > 46,8 (HR 4,37, 95% CI 2,48 - 7,68)。结论。乌克兰第三波冠状病毒病大流行的特点是重症患者人数较多,入院时血氧合水平较低;因此,需要氧气支持(57,23%)和在重症监护病房治疗(25,44%)的患者数量更多,死亡率更高(23,58%)。为及时发现高危人群,进行针对性监测,及早改变或加强治疗策略,确定以下潜在危险因素:年龄> 57岁,入院时有胸痛、神经肌肉症状,合并症2项以上,主要有动脉性高血压、糖尿病、脑血管疾病、冠心病、心力衰竭、心律失常,以及部分实验室指标:淋巴细胞水平≤0,66;Ast > 50,2;总蛋白≤66,1;肌酐> 102,7;尿素> 7,54;CRP > 46,8。关键词:COVID-19,住院患者,致命结局危险因素Ukr。Pulmonol。j . 2022; 30(4): 6 - 18。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CLINICAL AND LABORATORY FEATURES OF CORONAVIRUS DISEASE AND RISK FACTORS OF LETHAL OUTCOME IN PATIENTS WHO REQUIRED HOSPITALIZATION DURING THE THIRD WAVE OF COVID-19 IN UKRAINE: A SINGLE-CENTER RETROSPECTIVE STUDY
CLINICAL AND LABORATORY FEATURES OF CORONAVIRUS DISEASE AND RISK FACTORS OF LETHAL OUTCOME IN PATIENTS WHO REQUIRED HOSPITALIZATION DURING THE THIRD WAVE OF COVID-19 IN UKRAINE: A SINGLE-CENTER RETROSPECTIVE STUDY Т. О. Pertseva, K. Y. Gashynova, V. V. Rudakova, V. V. Rodionova, V. V. Dmytrychenko, O. Y. Kovalenko, O. V. Kravets, N. O. But, N. V. Laksha, L. A. Hlyniana, O. F. Mykhailenko, S. P. Novikov Abstract August 2021 in Ukraine marked the beginning of the third wave of COVID-19, catastrophic in terms of hospitalization and mortality, when, according to the Ministry of Health, the Delta strain was the dominant variant of the virus. By that time, it had already been established that clinical characteristics of patients and levels of inflammatory markers differed between Delta and non-Delta variants. The aim of the study was to analyze the anthropometric, clinical, anamnestic and laboratory characteristics of patients with COVID-19 who required hospitalization during the third wave of the epidemic in Ukraine, in order to determine the risk predictors of fatal outcome. Materials and methods. The study was a single-center retrospective analysis conducted on an original cohort of 632 patients who were admitted with confirmed COVID-19 to Public Non-profit Organization “City Clinical Hospital № 4” Dnipro City Council during August-October 2021. The following data were obtained and analyzed from the medical records of the studied patients: degree of severity at the time of admission according to the COVID-19 Severity Index, demographic characteristics, comorbidity, presentation, vital signs and laboratory parameters at admission, results of chest computed tomography, treatment options and the outcomes. Results. The patients’ median age was 63 years, 38,8 % were male. Hospital mortality rate was 23,58%. The median of bed count days — 9 [6, 12]. Fever (76,3 %), dyspnea (85,4 %), cough (53,3 %) and fatigue (49,5 %) were the most common clinical manifestations on admission. The percentage of patients with comorbidities was significantly higher among deceased (96,0 % vs. 56,1 %). The most prevalent were cardio- and neurometabolic comorbidities. The median SpO2 on admission was significantly lower among deceased — 86 [75, 90]. There were 25,44 % and 57,23 % of all hospitalized patients who received ICU care and oxygen therapy, respectively. The regression analysis revealed the age older than 57 years (HR 3,198, 95 % CI 1,992–5,134), neuromuscular symptoms (HR 2,033, 95 % CI 1,358–3,045) and chest pain (HR 1,867, 95 % CI 1,055–3,306), the presence of co-morbidity (HR 26,678, 95% CI 8,498–83,750), primarily arterial hypertension (HR 3,945, 95 % CI 2,725–5,712), coronary heart disease (HR 7,619, 95% CI 5,155–11,259), heart failure (HR 2,823, 95% CI 2,020–3,944), diabetes (HR 2,966, 95 % CI 2,095–4,200), arrhythmia (HR 2,247, 95 % CI 1,524–3,312), cerebrovascular diseases (HR 2,746, 95% CI 1,725–4,372) were reliable predictors of fatal outcome in COVID-19. At the same time, after conducting the regression analysis of initial laboratory parameters, the additional prognostic risk factors were revealed: lymphocyte level ≤ 0,66 (HR 1,81, 95 % CI 1,19–2,76), AST > 50,2 (HR 1,86, 95 % CI 1,15–3,02), total protein ≤ 66,1 (HR 1,55, 95% CI 1,02-2,36), creatinine > 102,7 (HR 2,57, 95 % CI 1,51–4,34), urea > 7,54 (HR 2,30, 95 % CI 1,41–3,75), CRP > 46,8 (HR 4,37, 95 % CI 2,48–7,68). Conclusion. The third wave of the coronavirus disease pandemic in Ukraine is characterized by a larger number of patients with a severe course and a lower level of blood oxygenation upon admission; accordingly, a more significant number of patients requiring oxygen support (57,23 %), treatment in the intensive care unit (25,44 %) and a higher mortality rate (23,58 %). For the timely identification of a high-risk group of patients with COVID-19 with the purpose of targeted monitoring and early change or intensification of treatment tactics, the following potential risk factors were determined: age > 57 years, presence of chest pain, and neuromuscular symptoms on admission to the hospital, more than 2 comorbidities, primarily, arterial hypertension, diabetes, cerebrovascular diseases, coronary heart disease, heart failure, and arrhythmia, as well as some laboratory indicators: lymphocyte level ≤ 0,66; AST > 50,2; total protein ≤ 66,1; creatinine > 102,7; urea > 7,54; CRP > 46,8. Key words: COVID-19, hospitalized patients, risk factors for lethal outcome Ukr. Pulmonol. J. 2022;30(4):6–18.
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