COVID-19病情进展相关临床特征的meta分析

Clinical Characteristics Associated with Progress of COVID-19: a Meta-analysis

关键词:  新型冠状病毒肺炎  年龄  呼吸困难  肺炎  乳酸脱氢酶  meta分析

Key words:  COVID-19  age  dyspnea  pneumonia  LDH  meta-analysis

摘要:

目的 探讨与COVID-19病情进展相关的危险因素。方法 检索COVID-19临床研究相关文献，截至2020年3月2日。采用Stata 12.0进行meta分析。共纳入7篇病例对照研究，涉及1 541例COVID-19患者，包括139例危重型和1 402例非危重型。比较2组患者入院时的临床特征、实验室检查结果、CT表现及并发症。结果 ①危重型患者的平均年龄显著高于非危重型患者[（62.13±14.08）vs（46.08±15.57），WMD=14.57，95%CI 13.28~15.86，P<0.001]。②伴有基础疾病的COVID-19患者更有可能发展为危重型（62.6% vs 23.0%，OR=4.90，95%CI 3.31~7.26，P<0.001），尤其是伴有慢性阻塞性肺病的患者（OR=14.71，95%CI 4.84~44.68，P<0.001）。发热是患者入院时最常见的症状（86.5%，1 297/1 500），但入院时体温高低与疾病进展的严重程度无关。③入院时出现呼吸困难和CT检查提示双侧肺炎的患者发展为危重型的风险增加（OR=6.83，95%CI 4.58~10.16，P<0.001；OR=1.80，95%CI 1.09~2.96，P=0.021）。④约51.7%和57.1%的COVID-19危重型患者并发急性呼吸窘迫综合征和心脏病变，而休克和肾损伤的发生率相对较低，分别为19.8%和8.6%。提示COVID-19患者在临床诊治过程中进行心、肺、肾功能检查十分重要。⑤危重型患者乳酸脱氢酶（LDH）水平显著高于非危重型患者[（434.84±208.68）vs（235.45±75.75），WMD=141.79，95%CI112.44~171.15，P<0.001]，并且LDH升高的患者更有可能发展为危重型（72.5% vs 37.9%，OR=3.94，95%CI 2.25~6.93，P<0.001），提示LDH水平与疾病严重程度相关。结论 高龄、存在基础疾病、入院时出现呼吸困难和双侧肺炎可能是COVID-19发展为危重型的潜在危险因素。LDH可作为疾病进展的临床监测指标。

Abstract:

OBJECTIVE To investigate the risk factors associated with the progress of COVID-19. METHODS Literatures search was performed to identify eligible studies published prior to March 2, 2020. Meta analysis were performed with Stata 12.0. Seven case-control studies were eligible involving 1 541 patients with COVID-19, including 139 critically ill patients and 1 402 non-critically ill patients. The clinical characteristics, laboratory findings, CT findings on admission and complications were compared between the two groups. RESULTS ①The mean age of critically ill patients was significantly higher than that of non-critically ill[(62.13±14.08) vs (46.08±15.57), WMD=14.57, 95%CI 13.28-15.86, P<0.001]. ②The patients with underlying comorbidities were more likely to progress to critically ill (62.6% vs 23.0%, OR=4.90, 95%CI 3.31-7.26, P<0.001), especially with chronic obstructive pulmonary disease (OR=14.71, 95%CI 4.84-44.68, P<0.001). Fever was the most common symptom on admission (86.5%, 1 297/1 500). However, the temperature was not related to the severity of the disease. ③The patients with dyspnea and bilateral involvement of CT scan on admission were associated with an increased risk of critically ill(OR=6.83, 95%CI 4.58-10.16, P<0.001; OR=1.80, 95%CI 1.09-2.96, P=0.021). ④About 51.7% and 57.1% of critically ill patients were complicated with acute respiratory distress syndrome and cardiac abnormalities. However, the incidence of shock and renal injury was relatively low, only 19.8% and 8.6%. This suggested that it was very important for COVID-19 patients to perform cardiac, pulmonary and renal function tests during the clinical diagnosis and treatment. ⑤The lactate dehydrogenase(LDH) level of critically ill patients was significantly higher than that of non-critically ill patients[(434.84±208.68) vs (235.45±75.75), WMD=141.79, 95%CI 112.44-171.15, P<0.001], and patients with elevated LDH were more likely to progress to critically ill (72.5% vs 37.9%, OR=3.94, 95%CI 2.25-6.93, P<0.001), suggesting that the LDH level was associated with the severity of the disease. CONCLUSION Old age, underlying comorbidities, dyspnea and bilateral pneumonia on admission may be potential risk factors for critically ill patients with COVID-19. LDH can be used as a monitoring index for disease progression.