Analysis of influencing factors and early clinical features of severe cases of COVID-19
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摘要:
目的 通过收集分析荆州市新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）病例流行病学资料，寻找病例重症化的影响因素及早期临床特征。 方法 利用χ2检验单因素分析筛选、Logistic回归分析模型寻找COVID-19病例重症化的影响因素和早期临床特征。 结果 荆州市累计报告1 580例确诊病例及临床诊断病例，重症病例占比23.61%（373/1 580）。多因素分析结果显示年龄≥49岁（OR=2.342，95% CI：1.803~3.043）、确诊病例（OR=2.772，95% CI：1.735~4.428）、有心脑血管疾病（OR=2.872，95% CI：1.542~5.349）是COVID-19病例临床结局演化为重症的危险因素；淋巴细胞百分比降低（OR=1.881，95% CI：1.105~3.202）、发热（OR=1.845，95% CI：1.340~2.541）、乏力（OR=1.616，95% CI：1.246~2.097）、气促（OR=1.870，95% CI：1.197~2.923）是COVID-19病例临床结局演化为重症的早期临床特征。 结论 年老者、患心脑血管疾病的COVID-19病例及早期出现发热、乏力、气促、淋巴细胞比降低的COVID-19病例均需警惕其重症化演变。 Abstract:Objective This paper aimed to found the risk factors and early clinical features of coronavirus disease 2019(COVID-19) severe cases by according to the epidemiological data of COVID-19 cases in Jingzhou City. Objective χ2 test and Logistic regression model analysis were used to sought the risk factors and early clinical features of COVID-19 cases. Results There were 1 580 confirmed and clinically diagnosed COVID-19 cases reported in Jingzhou City. The proportion of severe cases was 23.61% (373/1 580).Multivariate analysis showed that age ≥ 49 years (OR=2.342, 95% CI:1.803-3.043), confirmed cases (OR=2.772, 95% CI:1.735-4.428), cardiovascular and cerebrovascular diseases (OR=2.872, 95% CI:1.542-5.349) were the risk factors of COVID-19 severe cases, and lymphocyte percentage decrease (OR=1.881, 95% CI:1.105-3.202), fever (OR=1.845, 95% CI:1.340-2.541), fatigue (OR=1.616, 95% CI:1.246-2.097), chest tightness (OR=1.870, 95% CI:1.197-2.923) were the early clinical features of COVID-19 severe cases. Conclusions COVID-19 cases who were the el-derly, with cardiovascular diseases, and were fever, fatigue, chest tightness, and lymphocyte percentage decrease at early clinic stages should be on alert for its severe progression. -
表 1 Logistic回归分析模型变量及变量赋值情况
Table 1. Logistic regression model variables and variable assignments
变量 变量赋值 因变量 病例临床分型 轻症=0，重症=1 影响因素自变量 性别 女性=0，男性=1 年龄(岁) < 49岁=0，≥49岁=1 病例分类 临床诊断病例=0，确诊病例=1 发病至就诊间隔时间(d) < 6 d=0，≥6 d=1 是否患高血压 否=0，是=1 是否患糖尿病 否=0，是=1 是否患心脑血管疾病 否=0，是=1 有无暴露史 无=0，有=1 报告地区 其它县市=0，中心城区=1 早期临床特征自变量 白细胞计数变化 正常=1，升高=2，降低=3，缺失=4 淋巴细胞计数变化 正常=1，升高=2，降低=3，缺失=4 淋巴细胞百分比变化 正常=1，升高=2，降低=3，缺失=4 中性粒细胞百分比变化 正常=1，升高=2，降低=3，缺失=4 是否发热 否=0，是=1 是否干咳 否=0，是=1 是否咳痰 否=0，是=1 是否乏力 否=0，是=1 是否胸痛 否=0，是=1 是否胸闷 否=0，是=1 
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表 2 荆州市COVID-19重症病例单因素分析
Table 2. Single factor analysis of severe cases of COVID-19 in Jingzhou City
变量 病例数(例) 重症病例数(例) 重症病例占比(%) χ2值 P值 性别 3.216 0.075 男 834 212 25.4 女 746 161 21.6 年龄(岁) 61.745 < 0.001 < 49 785 119 15.2 ≥49 795 254 31.9 病例分类 21.372 < 0.001 临床诊断病例 215 24 11.2 确诊病例 1365 349 25.6 发病到就诊间隔(d) 7.411 0.008 < 6 741 152 20.5 ≥6 839 221 26.3 是否高血压 12.653 0.001 是 221 73 33.0 否 1 359 300 22.1 是否糖尿病 4.285 0.045 是 71 24 33.8 否 1 509 349 23.1 是否心脑血管疾病 21.071 < 0.001 是 49 25 51.0 否 1 531 348 22.7 有无暴露史 0.319 0.578 有 1 019 236 23.2 无 561 137 24.4 报告地区 3.571 0.059 中心城区 521 108 20.7 其他县市 1 059 265 25.0 早期临床特征自变量 白细胞计数变化 5.723 0.126 降低 337 79 23.4 正常 620 137 22.1 升高 39 15 38.5 缺失 584 142 24.3 淋巴细胞数变化 22.700 < 0.001 降低 200 72 36.0 正常 761 152 20.0 升高 22 5 22.7 缺失 597 144 24.1 淋巴细胞百分比变化 43.672 < 0.001 降低 322 114 35.4 正常 558 104 18.6 升高 103 10 9.7 缺失 597 145 24.3 中性粒细胞百分比变化 34.869 < 0.001 降低 141 18 12.8 正常 503 94 18.7 升高 340 114 33.5 缺失 596 147 24.7 是否发热 14.714 < 0.001 否 394 65 16.5 是 1 186 308 26.0 是否干咳 0.119 0.73 否 992 237 23.9 是 588 136 23.1 是否乏力 26.873 < 0.001 否 1 106 221 20.0 是 474 152 32.1 是否咳痰 0.035 0.852 否 1 255 295 23.5 是 325 78 24 是否气促 23.966 < 0.001 否 1 440 326 22.6 是 110 47 42.7 是否呼吸困难 14.612 < 0.001 否 1 468 330 22.5 是 112 43 38.4 是否胸闷 3.437 0.064 否 1 417 325 22.9 是 163 48 29.4
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表 3 荆州市COVID-19重症病例多因素分析
Table 3. Multivariate analysis of severe cases of COVID-19 in Jingzhou City
变量 β值 ${S_{\bar x}}$ Wald值 P值 OR(95% CI)值 性别 女性 1.000 男性 0.250 0.129 3.718 0.054 1.284(0.996~1.654) 年龄(岁) < 49 1.000 ≥49 0.851 0.134 40.616 < 0.001 2.342(1.803~3.043) 病例类型 临床诊断病例 1.000 确诊病例 1.020 0.239 18.210 < 0.001 2.772(1.735~4.428) 发病到就诊间隔(d) < 6 1.000 ≥6 0.169 0.130 1.679 0.195 1.184(0.917~1.529) 是否心脑血管疾病 否 1.000 是 1.055 0.317 11.062 0.001 2.872(1.542~5.349) 淋巴细胞数变化 正常 1.000 升高 0.355 0.550 0.417 0.519 1.426(0.486~4.187) 降低 0.391 0.201 3.792 0.051 1.478(0.997~2.191) 缺失 -0.473 0.601 0.619 0.431 0.623(0.192~2.024) 淋巴细胞百分比变化 正常 1.000 升高 -0.607 0.449 1.829 0.176 0.545(0.226~1.314) 降低 0.632 0.272 5.413 0.020 1.881(1.105~3.202) 缺失 -0.650 0.940 0.478 0.489 0.522(0.083~3.295) 中性粒细胞百分比变化 正常 1.000 升高 0.094 0.278 0.115 0.734 1.099(0.638~1.893) 降低 0.017 0.366 0.002 0.962 1.017(0.497~2.083) 缺失 1.613 0.911 3.132 0.077 5.018(0.841~29.942) 是否发热 否 1.000 是 0.613 0.163 14.078 < 0.001 1.845(1.340~2.541) 是否乏力 否 1.000 是 0.480 0.133 13.084 < 0.001 1.616(1.246~2.097) 是否气促 否 1.000 是 0.626 0.228 7.553 0.006 1.870(1.197~2.923) 是否呼吸困难 否 1.000 是 0.214 0.232 0.854 0.356 1.239(0.787~1.950)
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