Study On The Clinical Characteristics And Risk Factors Of Severe COVID-19 Cases In Anhui Province

Objective Analyze the clinical symptoms and signs,epidemiological characteristics and key information of COVID-19 in Anhui province.Compare the differences in clinical characteristics,diagnosis and treatment between severe and non-severe cases.To explore the influencing factors of severe cases.It provides a theoretical basis for identifying and treating severe patients in clinical work in the future.Methods From January to February 2020,421 COVID-19 confirmed cases that met the inclusion and exclusion criteria in COVID-19 designated medical institutions in 8prefecture level cities with a large number of cases in Anhui Province were investigated.According to their clinical classification,they were divided into 78 cases in the severe group and 343 cases in the non-severe group.The demographic characteristics,key time-interval and clinical characteristics of the two groups were compared and analyzed.This study uses Excel to establish the database and SPSS 23.0 statistical software for statistical analysis of data.Measurement data:first,the normality test is carried out.If it conforms to the normal distribution,it is described by Mean（?x）±Standard deviation（s）.The comparison between two or more groups of samples adopts Student’s t test or analysis of variance;The non-normal distribution is statistically described by Median（M）and Quartile(P₂₅,P₇₅),Comparison between groups was performed by Mann-Whitney U test.Counting data:expressed by Frequency（N）and Percentage（%）.For the comparison of the differences between the two groups,?^（17）test or Fisher exact test.Multivariate analysis:logistic regression analysis was used,P<0.05 was statistically significant.Results 1.Comparison of demographic characteristics:Among the 421 subjects included,238 were male（56.53%）and 183 were female（43.47%）.The age range of patients in the two groups ranged from 4 to 83 years old.The age,prevalence of diabetes and hypertension in the severe group was higher than that in the non-severe group（P<0.001）.2.Comparison of initial symptoms:the clinical initial symptoms of the two groups were different,including fever（41.02%vs 22.74%）,fatigue（20.51%vs 10.20%）,expectoration（14.10%vs 6.12%）,dyspnea（3.85%vs 0.87%）,and the proportion of fever,expectoration,fatigue and dyspnea in the severe group was higher than that in the non-severe group(?^（17）=11.008,5.762,6.343 and 3.994,all P<0.05).3.Comparison of key time-interval:the hospitalization time of patients in the severe group was longer than that in the non-severe group（Z=-3.672,P<0.001）;The time from onset to diagnosis was longer in the severe group,and the proportion of the two groups was more than 7 days（47.44%vs 31.20%）.4.Comparison of examination indexes:The creatine kinase isoenzyme MB,C-reactive protein,lactate dehydrogenase and white blood cell count in severe cases were significantly higher than those in non-severe cases.The levels of lymphocyte count,uric acid,eosinophils,albumin,total protein,sodium,phosphorus,potassium and calcium were significantly lower than those in non-severe group.5.Comparison of clinical diagnosis and treatment:the utilization rates of antibiotics,hormones and lopinavir/ritonavir in the severe group were higher;The utilization rate of traditional Chinese medicine was high in the non-severe group.6.Multivariate analysis showed:Lactate dehydrogenase（OR=1.01,95%CI=1.00-1.01）,age（OR=1.03,95%CI=1.00-1.05）,C-reactive protein（OR=1.01,95%CI=1.00-1.02）and previous diabetes mellitus（OR=7.52,95%CI=1.73-32.66）were positively correlated with the severity of the disease.Lymphocyte count（OR=0.34,95%CI=0.17-0.69）,calcium（OR=0.51,95%CI=0.28-0.92）,albumin（OR=0.91,95%CI=0.84-0.99）were negatively correlated with the severity of the diseaseConclusion The clinical features of COVID-19 in Anhui were similar to those in other regions.The elderly,the increase of lactate dehydrogenase and C-reactive protein levels and the decrease lymphocyte count,calcium and albumin levels,and previous diabetes are risk factors for severe COVID-19.Doctors should be alert to the changes of the above indexes when receiving patients.