| 张应涛,邓爱萍,胡婷,陈旭光,庄雅丽,谭小华,郑慧贞,孙立梅,李艳,钟豪杰,何剑峰,宋铁,康敏.广东省新型冠状病毒肺炎病例临床转归及其影响因素[J].中华流行病学杂志,2020,41(12):1999-2004 |
| 广东省新型冠状病毒肺炎病例临床转归及其影响因素 |
| Clinical outcomes of COVID-19 cases and influencing factors in Guangdong province |
| 收稿日期:2020-03-18 出版日期:2020-12-25 |
| DOI：10.3760/cma.j.cn112338-20200318-00378 |
| 中文关键词: 新型冠状病毒肺炎 临床转归 重症 影响因素 |
| 英文关键词: COVID-19 Clinical outcomes Severe illness Influencing factor |
| 基金项目:广东省重点领域研发计划项目（2019B111103001）；广东省医学科学技术研究基金（C2020013） |
| 作者 | 单位 | E-mail | | 张应涛 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 邓爱萍 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 胡婷 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 陈旭光 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 庄雅丽 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 谭小华 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | | | 郑慧贞 | 广东省疾病预防控制中心, 广州 510000 | | | 孙立梅 | 广东省疾病预防控制中心免疫所, 广州 510000 | | | 李艳 | 广东省疾病预防控制中心, 广州 510000 | | | 钟豪杰 | 广东省疾病预防控制中心卫生应急部, 广州 510000 | | | 何剑峰 | 广东省疾病预防控制中心, 广州 510000 | | | 宋铁 | 广东省疾病预防控制中心, 广州 510000 | | | 康敏 | 广东省疾病预防控制中心传染病预防控制所, 广州 510000 | kangmin@yeah.net |
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| 中文摘要: |
| 目的 分析广东省新型冠状病毒肺炎（COVID-19）病例的临床转归及其影响因素，为优化医疗救治及疫情防控的策略提供参考依据。方法 通过流行病学调查和进程追踪，收集广东省截至2020年3月4日COVID-19确诊病例1 350例的基本人口学特征、既往病史、就诊经过和临床转归等信息，分析确诊病例的临床分型、病程特点及其相关影响因素。结果 广东省COVID-19确诊病例1 350例中，临床分型为轻型、普通型、重型和危重型（重症）分别为5.3%（72/1 350）、77.7%（1 049/1 350）、12.1%（164/1 350）和4.3%（58/1 350），粗死亡率为0.5%（7/1 350）。病程时间中位数为23（P25，P75：18，31）d，住院时间中位数为20（P25，P75：15，27）d。出现重症时间中位数为发病第12（P25，P75：第9，15）天，重症持续时间中位数为8（P25，P75：4，14）d。1 066例已出院/死亡病例中，入院轻型病例出现普通型的占36.4%（36/99），出现重型的占1.0%（1/99）；入院普通型病例出现重型、危重型的分别占5.2%（50/968）、0.6%（6/968）；重型病例出现危重型的占11.4%（10/88）。病例出现重症的影响因素包括男性（aHR=1.87，95% CI：1.43~2.46）、年龄较大（aHR=1.67，95% CI：1.51~1.85）、发病至首诊第2~3天就诊（aHR=1.73，95% CI：1.20~2.50）、合并糖尿病（aHR=1.75，95% CI：1.12~2.73）、合并高血压（aHR=1.49，95% CI：1.06~2.09）。结论 广东省COVID-19病例病程和住院时间普遍较长，且与其临床分型严重程度有关，重症病例主要集中在特定人群，在疫情高发时期，为确保医疗资源的合理配置，需根据隔离和救治等防控需求对病例分类管理。 |
| 英文摘要: |
| Objective To analyze the clinical courses and outcomes of COVID-19 cases and the influencing factors in Guangdong province and provide basis for the formulation or adjustment of medical care and epidemic control strategy for COVID-19. Methods We collected demographic data, medical histories, clinical courses and outcomes of 1 350 COVID-19 patients reported in Guangdong as of 4 March 2020 via epidemiological investigation and process tracking. Disease severity and clinical course characteristics of the patients and influencing factors of severe illness were analyzed in our study. Results Among 1 350 cases of COVID-19 cases in Guangdong, 72 (5.3%) and 1 049 (77.7%) were mild and ordinary cases, 164 (12.1%) were severe cases, 58 (4.3%) were critical cases and 7 (0.5%) were fatal. The median duration of illness were 23 days (P25, P75:18, 31 days) and the median length of hospitalization were 20 days (P25, P75:15,27 days). For severe cases, the median time of showing severe manifestations was on the 12th day after onset (P25, P75:9th to 15th days), and the median time of severe manifestation lasted for 8 days (P25, P75:4, 14 days). Among 1 066 discharged/fetal cases, 36.4% (36/99) and 1.0% (1/99) of the mild cases developed to ordinary cases and severe cases respectively after admission; and 5.2% (50/968) and 0.6% (6/968) of the ordinary cases developed to severe cases, and critical cases respectively after admission. In severe cases, 11.4% developed to critical cases (10/88). The influencing factors for severe illness or worse included male (aHR=1.87, 95% CI:1.43-2.46), older age (aHR=1.67, 95% CI:1.51-1.85), seeking medical care on day 2-3 after onset (aHR=1.73, 95% CI:1.20-2.50) pre-existing diabetes (aHR=1.75, 95% CI:1.12-2.73) and hypertension (aHR=1.49, 95% CI:1.06-2.09). Conclusions The course of illness and length of hospitalization of COVID-19 cases were generally long and associated with severity of disease clinical outcomes. The severe cases were mainly occurred in populations at high risk. In the epidemic period, classified management of COVID-19 cases should be promoted according to needs for control and prevention of isolation and treatment for the purpose of rational allocation of medical resources. |
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