Dr. Zhou of the Chinese Academy of Medical Sciences conducted a retrospective follow-up study to clarify the epidemiological characteristics, such as risk factors for death in COVID-19, and reported it to the international medical journal The Lancet. rice field.
METHODS: By 31 January 2020, 813 adult patients were hospitalized in two study hospitals in Wuhan, China. Of these, 54 patients who died by January 31 and 137 who survived and were discharged from the hospital for a total of 191 patients whose important data items were not unknown were also included in the accumulated electronic medical record data. We then conducted a statistical analysis.
[Risk factors associated with death] As a result of the analysis, as shown in Table 1, the higher the age, the higher the SOFA score, which shows signs of sepsis and visceral disorders, and the sign of blood clots. High levels of dimers were associated with an increased risk of death. A high qSOFA score, which has the same significance as the SOFA score and can be easily determined, was also associated with a high risk of death. Regarding the signs of blood clotting in many of the patients who died, the reaction of inflammatory cytokines caused the rupture of blood clots, such as cholesterol, in the patient’s blood vessels, making it easier for blood to clot throughout the body. It is possible that it has changed.
The treatment given to the patient was the situation in Table 2. Antibiotic therapy was given to most patients to prevent or treat non-coronavirus bacterial infections. Existing antiviral drugs, steroid drugs that stop immune runaway, and immunoglobulin drugs that help the immune system are also being tried. Oxygen and mechanical ventilation were used in many deceased patients.
Of those who died, 100% eventually developed sepsis and 98% had respiratory failure. On the other hand, some of the surviving patients were temporarily in those conditions and recovered. Patients who died had a median of 10 days after symptom onset before becoming septic.
The median number of days until the virus cleared was 20 days, and the maximum was 37 days.
[Description of words]
A P-value of less than 0.05 is unlikely to be due to mere chance.
Median: The number of people in the middle when arranging in order from the highest value to the lowest value. If some people have very high values, the mean value can be higher than most people, so the median value is used in such cases.
SOFA Score: Originally used to determine sepsis, it is also used to assess other important visceral disorders. For each of the following 6 items, a score of 0 (normal) to 4 (very abnormal) is added and totaled.
(1) Breathing (oxygen concentration in blood)
(2) Coagulation (platelet count)
③ Liver (total bilirubin)
④ Cardiovascular (average blood pressure, etc.)
⑤Central nervous system (whether consciousness is clear)
⑥Kidney (blood creatinine and urine volume)
sofa Score: A more easily measurable alternative to the SOFA score. Septicemia and visceral disorders are judged to be possible when two or more of the following three items are met.
① Breathing speed (more than 22 times per minute)
② state of consciousness (not completely clear)
③ Systolic blood pressure (100mmHg or less)
D-dimer: A substance that forms when blood clots in blood vessels to form a thrombus. It increases in cases such as venous thromboembolism (so-called economy class syndrome) and DIC, which is a condition in which small blood clots form in blood vessels throughout the body.
Sepsis: A condition in which bacteria and viruses increase, inflammation spreads throughout the body, and damage to the internal organs occurs. In this study, the SOFA score was used to determine sepsis.
Respiratory failure: A condition in which the blood does not get enough oxygen.
Cytokines: Substances secreted by white blood cells that are responsible for immunity. Immunity is originally meant to protect the body against viruses and other viruses, but if there are too many inflammatory cytokines, it will accelerate inflammation and damage the body itself.
[References from this research paper]
This research paper is primarily written for physicians in charge of treating COVID-19. On the other hand, it can also serve as a reference for the general public.
Decreased pulmonary function as indicated by the sofa score, wheezing and breathing rate of 22 or more breaths per minute, unconsciousness or jerky responses, systole If your blood pressure (higher blood pressure number) drops below 100, it is considered necessary to receive solid treatment at a medical institution. Conversely, if you do not have these symptoms, you are likely to survive.
In addition, it can be seen that even in the period when the medical system was close to collapse in Wuhan, China, they worked hard to provide highly advanced treatment. And while there are people who recover with artificial respiration, etc., it can be seen that the situation is difficult even if advanced treatment is performed when it becomes a serious condition.