关键词:

新型冠状病毒肺炎, 危重症, 危险因素, 心电图, 倾向性评分匹配 ,

Abstract:

Objective To explore the high risk factors associated with severe and critical patients withcoronavirus disease⁃2019（COVID⁃19）by propensity score matching analysis（PSM），and to improve the ability ofthe early recognition and intervention，and thus to realize higher survival rate of these patients. Methods 292 patientswith laboratory confirmed COVID⁃19 admitted to the Third Hospital of Wuhan from January 27，2020 to March 18，2020 were selected. According to the symptoms，the patients were divided into two groups：213 mild/moderatepatients and 79 severe/critical patients. By PSM，a total of 165 cases were included，of which 101 were mild/mod⁃erate patients and 65 were severe/critical patients. Baseline characteristics，laboratory findings，clinical outcomeand ECG data of these patients were collected，and the risk factors of severe/critical patients with COVID⁃19 andtheir outcome were explored by using a COX model. Results Before PSM，The difference of age，sex，hyperten⁃sion，coronary heart disease history and the ratio of cardiovascular diseases with or less than 2 types of cardiovascu⁃lar system was statistically significant between the two groups. However，after PSM，there were no significant differ⁃ences（P > 0.05）. There were significant differences in WBC count and lymphocyte count between the two groupsbefore PSM（P < 0.05），while only WBC count after PSM was statistically significant（P < 0.05）. CRP increased，blood calcium decreased and mortality was high in observation group before and after PSM，and the differenceswere statistically significant（P < 0.05）. There were significant differences in ECG changes between the two groupsbefore PSM in premature beat，concave ST segment elevation and T wave depression（P < 0.05），but only the con⁃cave ST segment elevation after PSM was statistically significant（P < 0.05） Cox regression analysis showed that SpO2，WBC count and CRP were risk factors of severe/critical COVID⁃19 patients after adjusting for age，gender，lymphocyte count，hs ⁃TnI and blood calcium，the odds ratios（OR）were respectively 1.059（95% CI：1.003 ~1.119，P < 0.05），0.938（95% CI：0.921 ~ 0.955，P < 0.05），1.004（95% CI：1.001 ~ 1.007，P < 0.05）. ConcaveST segment elevation was not a risk factor for severe covid⁃19 patients，but an independent risk factor for death inCOVID⁃19 patients，OR was 3.095（95% CI：1.657 ~ 5.782，P < 0.05）. Conclusion According to propensitymatching analysis，decreased SpO2，increased white blood cell count and CRP were risk factors for severe covid⁃19patients. In addition to older age and decreased SpO2，concave ST segment elevation was an independent risk factorfor death in severe/critical COVID⁃19 patients.

Key words:

corona virus disease 2019, severe type, risk factors, ECG, propensity score matching