Objective: To explore the clinical characteristics and risk factors of patients with Coronavirus Disease 2019 (COVID-19) when developing multiple organ dysfunction syndrome (MODS). Methods: Data from 458 inpatients of confirmed COVID-19 in Wuhan, Shanghai and Tongling from December 29, 2019 to March 24, 2020 were retrospectively collected. COVID-19 was confirmed by real-time RT-PCR of throat swab samples. Data of demographics, clinical presentation, laboratory tests, imaging findings, treatment and prognosis were obtained from medical record and compared between COVID-19 patients with and without MODS. Risk factors for the development of MODS were analyzed by univariate and multivariate logistic regression analysis. Results: Of the 458 COVID-19 patients (266 from Wuhan, 208 from Shanghai, and 24 from Tongling), 103 developed transient or persistent MODS in the course. More male patients were found in those with MODS (72.8% vs 54.6%, P=0.001). And MODS patients were of older age (72.8% vs 54.6%, P=0.001), more chronic comorbidities (68.0% vs 43.4%, P<0.001), and longer onset-to-admission interval (9.0 vs 7.0 d, P<0.001). In addition, patients with MODS had more expectoration (45.6% vs 29.9%, P=0.003) and shortness of breath (52.4% vs 19.4%, P<0.001), dysfunction of various systems, decreased cellular immunity and elevated IL-6 (9.6 vs 7.6 g/L, P=0.015) in laboratory tests, isolation of other pathogens (18.4% vs 5.6%, P<0.001), and infiltration of all five lobes (75.3% vs 57.6%, P=0.003). During hospitalization, patients with MODS needed a higher proportion of comprehensive treatment and reached a mortality rate of 66.0%. Independents risk factors for development of MODS in COVID-19 patients were: onset-to-admission interval>7 days (OR=2.17, 95%CI: 1.11-4.22, P=0.023), shortness of breath (OR=3.19, 95%CI: 1.60-6.37, P=0.001), lymphocyte count<1×109/L (OR=2.67, 95%CI: 1.31-5.46, P=0.007), blood urea nitrogen>7mol/L (OR=6.27, 95%CI: 2.80-14.08, P<0.001), procalcitonin>0.1 ng/mL (OR=2.48, 95%CI: 1.20-5.13, P=0.014), and C-reactive protein>10 mg/L (OR=3.92, 95%CI: 1.41-10.89, P=0.009). Conclusions: COVID-19 patients with MODS were of higher severity and mortality. Early identification of high-risk groups with MODS according to risk factors may be helpful for early treatment.
目的： 探讨新型冠状病毒感染（COVID-19）患者并发多器官功能障碍综合征（MODS）的临床特点和危险因素。 方法： 回顾性纳入了2019年12月29日至2020年3月24日武汉、上海和铜陵三地458例确诊COVID-19的住院患者。通过对咽拭子标本进行实时荧光定量RT-PCR确诊COVID-19。从病历系统中收集患者的人口统计学、临床表现、实验室检查、影像学检查、治疗和预后特征并进行了MODS组和非MODS组的组间比较，通过单因素和多因素logistic回归分析COVID-19患者并发MODS的危险因素。 结果： 458例COVID-19患者中（武汉226例，上海208例，铜陵24例），103例患者在病程中出现了短暂或持续性MODS。并发MODS患者男性比例较高（72.8% vs 54.6%，P=0.001），年龄较大（63.0 vs 52.0岁，P<0.001），慢性合并症较多（68.0% vs 43.4%，P<0.001），发病-入院间隔较长（9.0 vs 7.0 d，P<0.001）；另外，并发MODS患者在入院时更多的出现咳痰（45.6% vs 29.9%，P=0.003）和气促（52.4% vs 19.4%，P<0.001），存在更多的各系统功能异常、细胞免疫下降和IL-6升高（9.6 vs 7.6 g/L，P=0.015），更常合并其他病原体检出（18.4% vs 5.6%，P<0.001）及全肺叶浸润（75.3% vs 57.6%，P=0.003）；在住院期间，并发MODS患者需要更高比例的综合性治疗，病死率高达66.0%。COVID-19患者并发MODS的独立危险因素为：入院-发病间隔>7 d（OR=2.17，95%CI：1.11~4.22，P=0.023），气促（OR=3.19，95%CI：1.60~6.37，P=0.001），淋巴细胞<1×109/L（OR=2.67，95%CI：1.31~5.46，P=0.007），尿素氮>7 mol/L（OR=6.27，95%CI：2.80~14.08，P<0.001），降钙素原>0.1 μg/L（OR=2.48，95%CI：1.20~5.13，P=0.014）和C反应蛋白>10 mg/L（OR=3.92，95%CI：1.41~10.89，P=0.009）。 结论： 并发MODS的COVID-19患者病情更重，病死率更高。依据危险因素早期识别发生MODS的高危人群可有助于开展早期治疗。.