目的 探讨引起新型冠状病毒感染（coronavirus disease 2019， COVID-19）向重型、危重型发展的早期预测因素。 方法 选择2022年12月至2023年3月广西医科大学第一附属医院重症医学科、感染病区、呼吸与危重症医学科住院治疗的COVID-19患者为研究对象，按住院期间病情程度分为轻/中型组、重型组、危重型组。收集3组患者的一般临床资料和早期实验室检查结果并进行比较。 结果 共纳入242例COVID-19患者，包括117例轻/中型患者，55例重型患者，70例危重型患者；男165例，女77例，中位年龄70（59，80）岁。三组患者在年龄、性别、糖尿病、心脏病、脑卒中、合并肺炎、合并血流感染、APACHEⅡ评分、入院时呼吸频率、收缩压以及早期白细胞计数（WBC）、淋巴细胞计数（LYM）、尿素、肌酐、白蛋白、C-反应蛋白、D-二聚体、降钙素原、白细胞介素-6（IL-6）比较差异有统计学意义（均P < 0.05）。有序logistic回归显示，既往心脏病、脑卒中、合并血流感染、WBC、IL-6水平高、LYM水平低是重型、危重型COVID-19的独立危险因素［优势比（OR）和95%置信区间（95%CI）分别为3.253（1.694 ~ 6.246）、5.251（2.378 ~ 11.592）、6.920（2.499 ~ 19.189）、1.111（1.041 ~ 1.186）、1.003（1.001 ~ 1.006）、0.571（0.353 ~ 0.926）］。ROC曲线分析显示，WBC、LYM、IL-6及三者联合检测对COVID-19的严重程度均有一定的预测价值（均P < 0.05），WBC、LYM与IL-6三者联合检测预测价值优于单一指标（P < 0.05）。 结论 既往心脏病、脑血管疾病、早期合并血流感染、入院时IL-6、WBC水平较高、LYM水平低是有助于早期预测COVID-19严重程度的独立危险因素。WBC、LYM与IL-6三者联合检测对COVID-19发展成重型、危重型有一定的预测价值。

Objective To explore the early predictors of the development of the novel coronavirus infection （COVID-19） into severe and critical forms. Methods COVID-19 patients hospitalized in the Department of Intensive Care Medicine， Infection ward， Respiratory and Critical Care Medicine of the First Affiliated Hospital of Guangxi Medical University from December 2022 to March 2023 were selected as the study objects， and were divided into mild/medium group， severe group， and critical group according to the severity of illness during hospitalization. General clinical data and early laboratory results of the three groups were collected and compared. Results A total of 242 patients with novel coronavirus infection were included， including 117 mild/medium patients， 55 severe patients， and 70 critically severe patients. There were 165 males and 77 females with a median age of 70 （59，80） years. The age， sex， diabetes， heart disease， stroke， combined pneumonia， combined bloodstream infection， APACHE Ⅱ score， respiratory rate on admission， systolic blood pressure， and early white blood cell count （WBC）， lymphocyte count （LYM）， urea， creatinine， albumin， C-reactive protein， D-dimer， interleukin-6 （IL-6）， and calcium reduction of patients in the three groups had significant （all P < 0.05）. Ordered logistic regression shows， previous heart disease， stroke， combined bloodstream infection， WBC， high IL-6 level， and low LYM level were independent risk factors for severe and critical COVID-19 infection ［odds ratio （OR） and 95% confidence interval （95%CI） were 3.253（1.694 ~ 6.246）， 5.251（2.378 ~ 11.592）， respectively. 6.920（2.499 ~ 19.189）， 1.111（1.041 ~ 1.186）， 1.003（1.001 ~ 1.006）， 0.571（0.353 ~ 0.926）］. ROC curve analysis showed that WBC， LYM， IL-6 and their combined detection had certain predictive value for the severity of COVID-19 （all P < 0.05）， and the combined detection of WBC， LYM and IL-6 had better predictive value than a single indicator （P < 0.05）. Conclusion Previous heart disease， cerebrovascular disease， early combination of bloodstream infection， high levels of IL-6， white blood cell count， and low lymphocyte levels at admission were independent risk factors that helped to predict the severity of COVID-19 infection early. The combined detection of WBC， LYM and IL-6 has certain predictive value for the development of severe and critical COVID-19.