重庆市新型冠状病毒肺炎患者并发急性呼吸窘迫综合征风险预测模型的建立

Risk factors associated with acute respiratory distress syndrome in patients with coronavirus disease 2019 and establishment of risk-prediction model in Chongqing

摘要:

目的：探讨重庆市新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）患者并发急性呼吸窘迫综合征（acute respi－ratory distress syndrome，ARDS）的危险因素，并构建其风险预测模型。方法：回顾性分析2020年1月16日至3月30日于重庆市4所定点医院收治的225例COVID-19患者临床资料。根据柏林定义标准将患者分为ARDS组和非ARDS组，比较2组患者一般资料、临床症状、实验室检查、影像学特征和预后的差异。采用二分类logistic回归获得独立危险因素，并根据各因素优势比（odds ratios，OR）进行赋值，以建立风险预测模型。应用受试者工作特征（receiver operating characteristic，ROC）曲线评价模型的预测效果。结果：225例患者中，男性141例，女性84例；年龄中位数56岁。62例患者（27.6%）并发ARDS。logistic回归分析显示，年龄≥60岁（OR=5.849，95%CI=2.716~12.593，P=0.000）、淋巴细胞计数≤1.0×109个/L（OR=4.318，95%CI=2.001~9.316，P=0.000）、D-二聚体≥0.5 mg/L（OR=3.049，95%CI=1.300~7.152，P=0.010）及合并糖尿病（OR=2.491，95%CI=1.102~5.632，P=0.000）为COVID-19并发ARDS的独立危险因素，并在此基础上建立风险预测模型。模型的ROC曲线下面积为0.848（95%CI=0.794~0.892，P=0.000）。结论：年龄≥60岁、淋巴细胞计数≤1.0×109个/L、D-二聚体≥0.5 mg/L及合并糖尿病是预测COVID-19患者并发ARDS的独立危险因素，基于此构建的风险预测模型对COVID-19并发ARDS具有较好的早期预警价值。

Abstract:

Objective：To explore the risk factors of acute respiratory distress syndrome（ARDS） occurrence in patients with coronavirus disease 2019（COVID-19） in Chongqing，and establish a risk-prediction model for the early diagnosis of ARDS. Methods：Clinical data of 225 laboratory-confirmed cases with COVID-19 admitted to 4 designated hospitals in Chongqing from January 16 to March 30，2020 were analyzed retrospectively. According to the Berlin definition，the patients were divided into ARDS group and non-ARDS group. The differences of initial baseline features，clinical manifestations，laboratory findings，imaging features and prognosis between the two groups were compared. The values were assigned accord－ing to the odds ratios（OR） of each factor to establish the risk-prediction model. The receiver operating characteristic（ROC） curve was used to evaluate the predictive effect of the model. Results：Among 225 patients，there were 141 males and 84 fe－males，and the median age was 56 years old. ARDS occurred in 62 cases（27.6%）. In the logistic analysis，4 variables（age≥60 years old，lymphocyte≤1.0×109/L，D-Dimer≥0.5 mg/L，com－plicated with diabetes） were determined as independent risk factors associated with ARDS in COVID-19 patients，and the odds ratios were 5.849（95%CI=2.716-12.593，P=0.000），4.318（95%CI=2.001-9.316，P=0.000），3.049（95%CI=1.300-7.152，P=0.010） and 2.491（95%CI=1.102-5.632，P=0.028） respectively. The area under the ROC curve of the risk-prediction model was 0.848（95%CI=0.794-0.892，P=0.000）. Conclusion：Age≥60 years old，D-dimer≥0.5 mg/L，lymphocyte≤1.0×109/L and complicated with diabetes are independent risk factors to predict ARDS in COVID-19 patients. The risk-prediction model based on the identified inde－pendent risk factors may have a good early warning value for COVID-19 patients complicated with ARDS.