Статья

Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Chaomin WuDepartment of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, ChinaXiaoyan ChenDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaYanping CaiInfection Division, Wuhan Jinyintan Hospital, Wuhan, ChinaJiaan XiaTuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, ChinaXing ZhouDepartment of Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSha XuInfection Division, Wuhan Jinyintan Hospital, Wuhan, ChinaHan-Ping HuangTuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, ChinaLi ZhangTuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, ChinaXia ZhouDepartment of Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaChunling DuDepartment of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, ChinaYuye ZhangDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaJuan SongDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaSijiao WangDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaYencheng ChaoDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaZeyong YangDepartment of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaJie XuDepartment of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, ChinaXin ZhouDepartment of Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDechang ChenDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaWeining XiongDepartment of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaLei XuDepartment of Emergency Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, ChinaFeng ZhouDepartment of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, ChinaJinjun JiangDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaChunxue BaiDepartment of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaJunhua ZhengDepartment of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaYuanlin SongDepartment of Pulmonary Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

2020en

ABI

Аннотация

Importance: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated. Objective: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died. Design, Setting, and Participants: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020. Exposures: Confirmed COVID-19 pneumonia. Main Outcomes and Measures: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed. Results: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72). Conclusions and Relevance: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.

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Идентификаторы

DOI: 10.1001/jamainternmed.2020.0994

Цитирования и источники

Цитирований: 5Использованных источников: 0

Показатели — AkademScholar