Abstract: Background　Since April 2020， the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad.Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients.Objective　To investigate the clinical features and prognostic risk factors of adult patients with COVID-19，offering a reference for clinical diagnosis and treatment of this disease.Methods　A retrospective design was used.Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020.They were categorized into common，severe and critical types by the most serious conditions during hospitalization，in accordance with the Diagnosis and Treatment Protocol for COVID-19（Trial Version 7）issued by the National Health Commission of the People's Republic of China.Indications such as general information，major clinical manifestations，baseline laboratory parameters，APACHE II and SOFA scores within 24 hours of admission，imaging findings，comorbidities and complications，treatments and outcomes were collected.Results　There were 57 cases of common type（61.3%），22 of severe type（23.7%）and 14 of critical type（15.0%）.The male ratio was slighter higher in critical group，and female ratio was slighter higher in other groups，but sex composition showed no significant differences across the groups（P>0.05）.The median age for common，severe and critical groups was 45.0，62.0 and 81.0 years，respectively，showing significant differences（P<0.05）.And the proportion of patients older than 60 years differed across common，severe and critical groups（15.8% vs 54.5% vs 92.9%）（P<0.05）.Compared with common and severe groups，the rate of positive-to negative inversion of SARS-CoV-2 viral load detected by nucleic acid test was decreased，the duration of viral shedding was prolonged，and the interval from onset to dyspnea was shortened，markedly in critical group（P<0.05）.Fever and cough were the most common clinical manifestations whose overall incidences were 88.2% and 87.1%，respectively，showing no significant difference among the groups（P>0.05）.Dyspnea occurred in all severe or critical cases，showing a higher incidence than common cases（100.0% vs 31.6%）（P<0.05）.The incidence of lymphocytopenia in critical group was 100%，which was significantly higher than that in common group（49.1%）or severe group（59.1%）（P<0.05）.Acute liver injury was the most common complication（58.1%）in all cases，but its incidence was obviously increased in severe group （77.3%） or critical group（92.9%），than that of common group（42.1%）（P<0.05）.Chinese medicine therapy was used in 75.3% of all cases，but the severe cases had a higher rate of treating with Chinese medicine than critical cases（90.9% vs 50.0%，P<0.05）.The rate of corticosteroid use in severe cases（63.6%）or critical cases（64.3%）was significantly increased than that of common cases（5.3%）（P<0.05）.Six patients（6.5%）were treated with invasive ventilation， but only 1 of them（16.7%）was successfully extubated ultimately.Nine patients（9.7%）died in hospital due to all causes.Logistic regression analysis revealed that age ≥74 years〔OR（95%CI）=33.714（3.021，376.211），P=0.004〕and baseline SOFA≥2.5〔OR（95%CI）=15.447（1.331，179.260），P=0.029〕were independent risk factors for in-hospital death. Conclusion　COVID-19 mainly manifests as respiratory infections. Severe patients are apt to appear tissue injury and dysfunction of organs like liver， kidney and heart， etc. The majority of patients have a favorable outcome. Age and baseline SOFA score would help to label the prognosis of patients at an early stage.

Key words: Corona virus disease-19, SARS-CoV-2, Clinical feature, Adults, Prognosis, Risk factor

摘要： 背景　2020年3月后，我国新增确诊新型冠状病毒肺炎（COVID-19）及死亡病例明显减少，但境外确诊病例快速增加，早诊断、早治疗对改善COVID-19患者预后意义重大。目的　探讨COVID-19成人患者的临床特征及预后相关危险因素，为临床诊疗工作提供参考。方法　回顾性分析2020年1—2月北京佑安医院收治的93例成人COVID-19患者的临床资料，参考国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案（试行第七版）》病情分型，依据住院期间最严重病情将患者分为：普通型组、重型组、危重型组。收集患者一般资料、主要临床表现、入院24 h内基线实验室检查指标、入院24 h内急性生理学和慢性健康评估量表（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分、影像学检查、合并症和并发症、治疗及结局。结果　COVID-19患者中普通型57例（61.3%）、重型22例（23.7%）、危重型14例（15.0%）。普通型、重型患者以女性为主，危重型患者以男性为主，但组间性别构成差异无统计学意义（P>0.05）。普通型组、重型组、危重型组中位年龄分别为45.0、62.0、81.0岁，各组>60岁患者比例分别为15.8%、54.5%及92.9%，组间比较差异有统计学意义（P<0.05）。相比普通型组及重型组，危重型组SARS-CoV-2核酸转阴率较低，发病后病毒脱落持续时间较长，发病至出现呼吸困难间隔时间较短（P<0.05）。发热、咳嗽是最常见临床表现，总体发生率分别为88.2%及87.1%，但各组间发生率差异无统计学意义（P>0.05）。重型、危重型组呼吸困难发生率为100%，明显高于普通型组（31.6%）（P<0.05）。危重型组淋巴细胞减少的发生率为100%，明显高于普通型组（49.1%）及重型组（59.1%）（P<0.05）。急性肝损伤是最常见并发症（58.1%），其在重型组及危重型组中发生率（77.3%、92.9%）明显高于普通型组（42.1%）（P<0.05）。中药总体使用率为75.3%，其中重型组中药使用率（90.9%）显著高于危重型组（50.0%）（P<0.05）。糖皮质激素在重型组（63.6%）及危重型组（64.3%）的使用率明显高于普通型组（5.3%）（P<0.05）。6例（6.5%）患者行有创正压通气治疗，拔管成功率仅为16.7%（1例）。9例患者死亡，全因病死率9.7%。Logistic回归分析示年龄≥74岁〔OR（95%CI）=33.714（3.021，376.211），P=0.004〕、基线SOFA评分≥2.5分〔OR（95%CI）=15.447（1.331，179.260），P=0.029〕是患者院内死亡的独立危险因素。结论　COVID-19以呼吸系统感染为主要临床表现，重症患者更易出现肝、肾、心等脏器组织损伤及功能障碍；多数患者预后良好，年龄及基线SOFA评分可用于早期评估患者预后。

关键词: 新型冠状病毒肺炎, 新型冠状病毒, 临床特征, 成年人, 预后, 危险因素