背景:流行病学因素,临床特征,并研究了COVID-19患者死亡的危险因素,但是互补系统的作用,可能的炎症和免疫反应机制,和详细的临床课程是不确定的,需要进一步研究。方法:在这个单一中心,回顾性病例对照研究,我们纳入了2020年1月3日至3月30日在武汉同济医院转诊或收治的所有COVID-19住院患者,这些患者具有明确的临床结局(治愈或死亡),并有完整的实验室和放射学结果.从电子病历中提取临床数据,并比较治愈和死亡患者。ROC曲线用于评估临床参数的预后价值。并进行多变量logistic回归分析以探讨死亡的危险因素.通过Spearman相关分析评价变量之间的相关性。结果:208例患者被纳入本研究,182例患者治愈出院,26例患者死于COVID-2019。大多数病人有合并症,高血压是最常见的慢性疾病(80;38%)。发病时最常见的症状是发热(149;72%),咳嗽(137;66%),呼吸困难(113;54%)。白细胞升高,中性粒细胞,炎症生物标志物(CRP,铁蛋白,IL6,IL8,降钙素原),PT,D-二聚体,心肌酶,BUN,淋巴细胞和亚群减少(T细胞,CD4T细胞,CD8T细胞,NK细胞,T细胞+B细胞+NK细胞),免疫因素(C3,C4)显示预后较差。PT,通过逻辑回归模型证实C3和T细胞是死亡率的独立预后因素。IL6和CPR与中性粒细胞呈正相关,但除B细胞外,淋巴细胞和淋巴细胞亚群呈阴性。IL8和铁蛋白与T细胞和CD4T细胞呈负相干。C3和T细胞之间存在正相关,CD4T细胞,和CD8T细胞,而C4和淋巴细胞亚群之间没有显着相关性。发现PT与IL6,IL8和CRP呈正相关。研究了C3、C4和PT之间的反向相关性,CK-MB,总胆红素。结论:T细胞,C3和PT被确定为死亡率的独立预后因素。SARS-CoV-2感染后,C3和C4减少,淋巴细胞亚群和细胞因子调节异常可能导致死亡。
Background: Epidemiological factors, clinical characteristics, and risk factors for the mortality of COVID-19 patients have been studied, but the role of complementary systems, possible inflammatory and immune response mechanisms, and detailed clinical courses are uncertain and require further study. Methods: In this single center, retrospective
case-control study, we included all COVID-19 inpatients transferred or admitted to Wuhan Tongji Hospital from January 3 to March 30 2020 who had definite clinical outcomes (cured or deceased) with complete laboratory and radiological results. Clinical data were extracted from the electronic medical records, and compared between the cured and deceased patients. ROC curves were used to evaluate the prognostic value of the clinical parameters, and multivariable logistic regression analysis was performed to explore the risk factors for mortality. The correlation between the variables was evaluated by Spearman correlation analysis. Results: 208 patients were included in this study, 182 patients were cured and discharged, 26 patients died from COVID-2019. Most patients had comorbidities, with hypertension as the most common chronic disease (80; 38%). The most common symptoms at onset were fever (149; 72%), cough (137; 66%), and dyspnea (113; 54%). Elevated leucocytes, neutrophils, inflammatory biomarkers (CRP, ferritin, IL6, IL8, procalcitonin), PT, D-dimer, myocardial enzymes, BUN, decreased lymphocyte and subsets (T cells, CD4 T cells, CD8 T cells, NK cells, T cells + B cells + NK cells), and immunological factors (C3, C4) indicated poor outcome. PT, C3, and T cells were confirmed as independent prognostic factors for mortality by logistic regression models. IL6 and CPR were positively correlated with neutrophils, but negatively with lymphocytes and lymphocyte subsets except B cells. IL8 and ferritin were negatively related to T cells and CD4 T cells. Positive associations existed between C3 and T cells, CD4 T cells, and CD8 T cells, whereas there was no significant correlation between C4 and lymphocyte subsets. PT was found positively correlated with IL6, IL8, and CRP. Reverse correlations were explored between C3, C4, and PT, CK-MB, total bilirubin. Conclusions: T cells, C3, and PT were identified as independent prognostic factors for mortality. Decreased C3 and C4, dysregulation of lymphocyte subsets and cytokines may lead to death after SARS-CoV-2 infection.