8例新型冠状病毒肺炎死亡病例临床特征分析

目的 探讨8例新型冠状病毒肺炎(简称新冠肺炎)死亡病例的死亡原因及可能危险因素。 方法 回顾性分析自2020年1月23日—2月25日在武汉市第五医院住院期间死亡的8例新冠肺炎病例的临床特征。 结果 8例新冠肺炎病例的死亡年龄在65~75岁之间,平均年龄(70.63±3.99)岁,平均病程 (12±2.83)d;8例病例均有明确基础疾病,其中最常见为高血压,其次为脑梗死、糖尿病、冠心病、肺部基础疾病;除肺脏损害外,其他器官损害主要有心脏,其次为肾脏、肝脏,凝血系统功能紊乱,其中4例(4/8)病例D2聚体明显升高;白细胞计数升高6例(6/8)、中性粒细胞计数升高6例(6/8)、C反应蛋白(C-reactive protein, CRP)升高8例(8/8)、降钙素原(procalcitonin, PCT)升高8例(8/8)、淋巴细胞计数下降4例(4/8)、淋巴细胞百分比下降8例(8/8)。病例死亡前一次白细胞计数(8/8)、中性粒细胞计数(8/8)、CRP(8/8)、降钙素原(8/8)、D2聚体(8/8)水平较入院时升高,血氧分压(8/8)、淋巴细胞计数(7/8)、淋巴细胞比率(8/8)较入院时降低,差异有统计学意义(P<0.05)。胸部CT显示肺部影像学较入院时病灶增多、范围增大。 结论 高龄及合并有基础疾病是新冠肺炎抢救困难甚至死亡的重要危险因素,细菌感染可能对疾病进展起着重要促进作用,血氧分压、胸部CT、白细胞计数、中性粒细胞计数、淋巴细胞计数、淋巴细胞百分比、CRP、降钙素原、D2聚体可能是疾病进展、预后不良的重要参考指标。

Clinical characteristics of 8 death cases with coronavirus disease 2019

Objective To explore the death causes and possible risk factors of 8 death cases with coronavirus disease 2019 (COVID-19). Methods We retrospectively analyzed the clinical characteristics of 8 COVID-19 cases which died duringhospitalization from January 23 to February 25 in 2020. Results The 8 death cases with COVID-19 were between the ages of 65 and 75, the mean age was (70.63±3.99) years and the average course of disease was (12±2.83) days. All the 8 death cases had underlying diseases, and the most common disease was hypertension, followed by cerebral infarction, diabetes, coronary heart disease and underlying diseases related to lung. Besides lung damage, heart, kidney and liver damages and coagulation dysfunction were also observed, and the level of D-dimer increased significantly in 4 (4/8) death cases. Leukocyte and neutrophil counts and the levels of C-reactive protein (CRP) and procalcitonin (PCT) were elevated in 6(6/8), 6(6/8), 8(8/8) and 8(8/8) cases, respectively. Lymphocyte count declined in 4 (4/8) cases, and lymphocyte percentage in 8 (8/8) cases. The levels of leukocyte (8/8), neutrophil (8/8), PCT (8/8) and D-dimer (8/8) in the last test before death were increased as compared with those in the first test during hospitalization, whereas the level of PaO2 (8/8), lymphocyte count (7/8) and lymphocyte percentage (8/8) were decreased as compared with those in the first test during hospitalization, showing statistically significant differences (all P<0.05). Chest CT showed an increased number and range of lung lesions as compared with admitting hospital. Conclusions Advanced age and underlying diseases are the important risk factors for the difficulty of COVID-19 rescue and even death, and bacterial infection may play an important role in promoting the progression of the disease. Pa02, chest CT, the counts of leukocyte, neutrophil and lymphocyte, lymphocyte percentage, CRP, PCT and D-dimer may be used as important reference indicators for disease progression and poor prognosis.