湖北省洪湖市ICU成年COVID-19患者的临床特征和结局分析

目的 描述成年重症COVID-19 患者的临床特征及结局病探讨其院内死亡的危险因素。方法 本研究纳入了来自湖北省荆州市洪湖市人民医院重症监护病房的确诊为COVID-19的20名成人患者，根据最后的结局分为生存组和死亡组，10人/组。 从电子病历中获取人口学、临床表现及体征、实验室指标、治疗措施和临床结局等数据，总结ICU成年COVID-19患者的临床特征和结局分析。通过使用单因素Logistic分析两组与院内死亡相关的危险因素。结果 COVID-19确诊患者的平均年龄为70 ±12岁，其中40%为男性，起病11±9 d后入住ICU。入院时最常见的症状分别是咳嗽（19例，95%）、乏力或肌痛（18例，90%）、发热（17例，85%）和呼吸困难（16例，80%）。11名（55%）患者有基础疾病，其中高血压最常见（11例，55%），其次是心血管疾病（4例，20%）和糖尿病（3例，15%）。6人（30%）接受了有创机械通气和持续肾脏替代治疗，并最终死亡。急性心脏损伤是最常见的并发症（19例，95%）。50%的患者（10人）在入住ICU后第2~19天之间死亡，相较于死亡患者，生存患者的平均体质量更低（61.70± 2.36 vs 68.60±7.15，P=0.01），格拉斯哥昏迷评分更高（14.69±0.70 vs 12.70±2.45，P=0.03），更少并发休克（2 vs 10，P=0.001）和急性呼吸窘迫综合征（2 vs 10，P=0.001）。结论 患有 COVID-19 的危重患者年龄较高，体质量较重、淋巴细胞计数减少可能是ICU中COVID-19患者死亡的潜在危险因素。     

武汉市COVID-19住院患者急性肾损伤的发生：287例单中心回顾性分析

ObjectiveTo assess the predictors and outcomes of acute kidney injury (AKI) among patients with coronavirus disease 2019 (COVID-19).MethodsThis retrospective observational study was conducted among patients with a confirmed diagnosis of COVID-19 admitted to Hankou Hospital between January, 5 and March 8, 2020. We evaluated the association of AKI with the demographic and biochemical parameters and clinical outcomes of the patients using univariate regression analysis.ResultsAtotal of 287 COVID-19 patients, including 55 with AKI and 232 without AKI, were included in the analysis. Compared with the patients without AKI, the patients with AKI were older, predominantly male, and were more likely to have hypoxia and pre-existing hypertension and cerebrovascular diseases. The patients with AKI also had higher levels of white blood cells, D-dimer, aspartate aminotransferase, total bilirubin, creatine kinase, lactate dehydrogenase, procalcitonin, C-reactive protein, a higher prevalence of hyperkalemia, lower lymphocyte counts, and higher chest computed tomographic scores. The incidence of stage 1 AKI was 14.3% and that of stage 2 or 3 AKI was 4.9%. The patients with AKI had much higher mortality rate than those without AKI.ConclusionsAKI is an important complication of COVID-19. An older age, a male gender, multiple pre- existing comorbidities, lymphopenia, increased infection indicators, elevated D-dimer, and impaired heart and liver functions are all potential risk factors ofAKI. COVID- 19 patients with AKI that progresses into stages 2 or 3 AKI have a high mortality rate. Prevention of AKI and monitoring kidney function is critical in the care of COVID-19 patients.     

VA-ECMO患者院内死亡风险预测模型的构建及验证：一项多中心、回顾性、病例对照研究

目的 分析静脉-动脉体外膜肺氧合技术（VA-ECMO）患者死亡危险因素,构建并验证VA-ECMO患者院内死亡风险预测模型。方法 采用便利抽样,选取2015年1月～2022年1月广东省3家三甲综合医院ICU的302例VA-ECMO患者作为研究对象,随机分为建模组201例,验证组101例。运用单因素及多因素Logistic回归分析VA-ECMO患者死亡危险因素,构建VAECMO患者死亡风险预测模型并以列线图形式呈现。使用受试者工作特征曲线（ROC曲线）、校准曲线和临床决策曲线评价模型区分度、一致性及临床有效性。结果 预测VA-ECMO患者院内死亡风险的最终模型包括了高血压（OR=3.694,95%CI 1.582-8.621）、连续性肾脏替代治疗（OR=9.661,95%CI 4.103-22.745）、钠离子（OR=1.048,95%CI 1.003-1.095）、血红蛋白（OR=0.987,95%CI 0.977-0.998）。建模组预测模型的受试者工作特征曲线下面积AUC=0.829(95%CI 0.770-0.889),高于4个单独危险因素（AUC<0.800）、APACHE...