COVID-19患者239人の重症患者における臨床経過と60日死亡率の予測因子：中国武漢市の多施設レトロスペクティブ研究

Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China.

• Jiqian Xu
• Xiaobo Yang
• Luyu Yang
• Xiaojing Zou
• Yaxin Wang
• Yongran Wu
• Ting Zhou
• Yin Yuan
• Hong Qi
• Shouzhi Fu
• Hong Liu
• Jia'an Xia
• Zhengqin Xu
• Yuan Yu
• Ruiting Li
• Yaqi Ouyang
• Rui Wang
• Lehao Ren
• Yingying Hu
• Dan Xu
• Xin Zhao
• Shiying Yuan
• Dingyu Zhang
• You Shang

抄録

背景:

COVID-19の確定症例や死亡した重症患者数は世界的に増加しているが，その臨床経過や60日死亡率の予測因子は十分に解明されていない．しかし，重症患者の臨床経過，60日死亡率とその予測因子は十分に解明されていない．本研究の目的は，COVID-19患者の臨床経過，60日死亡率とその予測因子を明らかにすることである．

BACKGROUND: The global numbers of confirmed cases and deceased critically ill patients with COVID-19 are increasing. However, the clinical course, and the 60-day mortality and its predictors in critically ill patients have not been fully elucidated. The aim of this study is to identify the clinical course, and 60-day mortality and its predictors in critically ill patients with COVID-19.

方法:

中国武漢市の 3 つの病院から集中治療室（ICU）に入院した重症成人患者を対象とした。人口統計学的情報、既往症、ICU 入院時の検査所見、治療、臨床転帰、SARS-CoV-2 RNA 検査および血清 SARS-CoV-2 IgM 検査の結果について、症状発症から SARS-CoV-2 RNA の陰性転換までの期間を含めてデータを収集した。

METHODS: Critically ill adult patients admitted to intensive care units (ICUs) from 3 hospitals in Wuhan, China, were included. Data on demographic information, preexisting comorbidities, laboratory findings at ICU admission, treatments, clinical outcomes, and results of SARS-CoV-2 RNA tests and of serum SARS-CoV-2 IgM were collected including the duration between symptom onset and negative conversion of SARS-CoV-2 RNA.

結果:

COVID-19患者1748例のうち、239例（13.7％）が重症患者であった。合併症は急性呼吸窮迫症候群（ARDS）164例（68.6％）、凝固障害150例（62.7％）、急性心障害103例（43.1％）、急性腎障害119例（49.8％）であり、それぞれ症状発現から15.5日後、17日後、18.5日後、19日後に発生した。SARS-CoV-2 RNA の陰性転換期間の中央値は、同定された重症生存者 49 例で 30 日（範囲 6～81 日）であった。合計 147 例（61.5%）の患者が ICU 入室後 60 日以内に死亡した．ICU入室から死亡までの期間の中央値は12日（範囲3-36）であった。Cox比例ハザード回帰分析の結果、65歳以上の年齢、ICU入院時の血小板減少症、ARDS、AKIは60日死亡率を独立して予測した。

RESULTS: Of 1748 patients with COVID-19, 239 (13.7%) critically ill patients were included. Complications included acute respiratory distress syndrome (ARDS) in 164 (68.6%) patients, coagulopathy in 150 (62.7%) patients, acute cardiac injury in 103 (43.1%) patients, and acute kidney injury (AKI) in 119 (49.8%) patients, which occurred 15.5 days, 17 days, 18.5 days, and 19 days after the symptom onset, respectively. The median duration of the negative conversion of SARS-CoV-2 RNA was 30 (range 6-81) days in 49 critically ill survivors that were identified. A total of 147 (61.5%) patients deceased by 60 days after ICU admission. The median duration between ICU admission and decease was 12 (range 3-36). Cox proportional-hazards regression analysis revealed that age older than 65 years, thrombocytopenia at ICU admission, ARDS, and AKI independently predicted the 60-day mortality.

結論:

重篤な合併症は一般的であり、COVID-19を有する重症患者の60日死亡率はかなり高い。SARS-CoV-2 RNAの陰性転換期間とCOVID-19患者の重症度との関連を真剣に検討し、さらに研究を進めるべきである。

CONCLUSIONS: Severe complications are common and the 60-day mortality of critically ill patients with COVID-19 is considerably high. The duration of the negative conversion of SARS-CoV-2 RNA and its association with the severity of critically ill patients with COVID-19 should be seriously considered and further studied.