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1月14日,国务院联防联控机制召开新闻发布会,会上国家卫生健康委员会医政司司长焦雅辉表示:通过分析显示,2022年12月8日至2023年1月12日,全国医疗机构累计发生在院新冠病毒感染相关死亡病例59938例,其中新冠病毒感染导致呼吸功能衰竭死亡病例5503例。
通过分析显示,2022年12月8日至2023年1月12日,全国医疗机构累计发生在院新冠病毒感染相关死亡病例59938例,其中新冠病毒感染导致呼吸功能衰竭死亡病例5503例,基础疾病合并新冠病毒感染死亡病例54435例,死亡病例平均年龄80.3岁,65岁及以上约占90.1%,其中80岁及以上约占56.5%。死亡病例中90%以上合并有基础疾病,主要合并疾病为心血管疾病、晚期肿瘤、脑血管疾病、呼吸系统疾病、代谢性疾病及肾功能不全等。
今天英语演讲分享一个国外医生Mike Hansen关于如何预测哪些患者更有可能死于新冠的视频。
哪些新冠肺炎患者更有可能死亡
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Several studies have come out about the COVID prognosis. As a result, we now have a powerful way to predict which patients with COVID pneumonia are more likely to die and require longer stays in the hospital. 
We already know that less than 15% of people who get COVID have a severe disease to the point of requiring hospitalization. Less than 5% of people who get covid require ICU. For those with COVID pneumonia who require ICU, and for some of the other patients in the hospital who might not necessarily need ICU, these are the patients who have the cytokine storm that we keep hearing about, meaning the immune system is going haywire. 
There is a ton of inflammation in the body….especially the lungs. But now, we have a more specific way of predicting who is more likely to develop cytokine storm, and therefore more likely to die, and who is more likely to require a more extended stay in the hospital….and it's based on the bloodwork we get when patients are hospitalized.When we get bloodwork, we do various lab tests. It is most commonly a complete blood count, CBC, and a complete metabolic panel or CMP. 
We often check other things like troponin, d-dimer, LDH, ferritin, and CRP. A complete blood count is specifically looking at 3 things: hemoglobin levels, platelets, and white blood cells. We can use the total number and the breakdown of the percentages of the types of white blood cells, meaning what percentage are neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Lymphocytes generally make up about 15-45% of WBC. This is very important as it pertains to COVID, and you'll see why in a little bit. 
The CMP stands for the complete metabolic pan looking at sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose calcium, bilirubin, albumin, and liver enzymes like AST ALT alkaline phosphatase. Some of these also have important implications for COVID disease severity. Because In the recent study done at Temple University, they analyzed over 500 hospitalized COVID patients, all of which had inflammation in their lungs seen on a CT scan of the chest (show). They determined the criteria for COVID cytokine storm. 
For patients who met these criteria, their length of stay in the hospital was 15 days, compared to 6 days if they did not meet the criteria. Mortality was 28.8% in the group that met the criteria, vs. 6.6% in those who did not. So if they met cytokine storm criteria, their likelihood of dying was 4 times higher. And how accurate was this prediction model? Pretty accurate, as this study had a specificity of 79% and a sensitivity of 85%, which is a lot of predictive power. 
Most of the patients who met the criteria for CS did so at the time of admission or shortly after. This suggests an early and rapid progression in these patients and that there is a low likelihood of developing cytokine storms after 10 days of hospitalization. So based on these specific lab parameters, this is how doctors can predict which patients are more likely to die of COVID. 
I find that this study correlates with what I've seen in my personal experience with hospitalized covid patients. And yes, the man whose CT scan I showed you earlier in this video met all of these criteria for cytokine storm, and he did so as soon as 24 hours of being admitted to the hospital.
关于COVID 19预后的研究很多。现在,我们有一种有效的方法来预测哪些COVID 19肺炎患者更有可能死亡,并且更有可能需要更长的住院时间。
我们已经知道,只有不到15%的获得COVID 19的人患有严重疾病,需要住院治疗。不到5%的冠状病毒感染者需要ICU。对于需要ICU的COVID 19肺炎患者,以及医院中某些不一定需要ICU的患者,这些患者是我们不断听到的细胞因子风暴的患者,这意味着免疫系统陷入困境,并且体内发生大量炎症……尤其是肺部。但是现在,我们有了一种更具体的方法来预测谁更可能发生细胞因子风暴,从而更可能死亡,谁更可能需要更长的住院时间……这是基于我们得到的血液数据患者住院时。
进行血液检查时,我们会进行各种实验室测试。最常见的是全血细胞计数或CBC,以及完整的代谢检测板或CMP。我们还经常检查其他内容,例如肌钙蛋白,d-二聚体,LDH,铁蛋白和CRP。完整的血细胞计数特别关注三个方面:血红蛋白,血小板和白细胞的水平。我们不仅可以看到白细胞总数,还可以看到白细胞类型百分比的细目分类,即中性粒细胞,单核细胞,淋巴细胞,嗜酸性粒细胞和嗜碱性粒细胞的百分比。淋巴细胞通常占WBC的15%至45%。这是非常重要的,因为它与COVID-19有关,并且稍后您将了解原因。
CMP代表完整的代谢指标,即钠,钾,氯,碳酸氢盐,血尿素氮,肌酐,葡萄糖,钙,胆红素,白蛋白和肝酶(如AST,ALT和碱性磷酸酶)的水平。当涉及COVID 19疾病严重程度时,其中一些也具有重要意义。因为在天普大学进行的最新研究中,他们分析了500例住院的COVID-19患者,所有患者的胸部CT扫描均显示其肺部有炎症(显示)。他们确定了COVID 19细胞因子风暴的标准。对于符合这些标准的患者,他们平均住院时间为15天,而如果不符合标准,则为6天。
符合标准的人群的死亡率为28.8%,而不符合标准的人群的死亡率为6.6%。因此,如果他们符合细胞因子风暴标准,那么他们死亡的可能性就会高出4倍。这个预测模型的准确性如何?相当准确,因为这项研究的特异性为79%,灵敏度为85%,具有很大的预测能力。符合CS标准的大多数患者在入院时或入院后不久就这样做了。这表明这些患者的早期和快速进展,也表明住院10天后发生细胞因子风暴的可能性很小。
因此,根据这些特定的实验室参数,医生可以通过这种方式预测哪些患者更有可能死于COVID-19。而且我确实发现这项研究与我在住院的狂犬病患者的亲身经历中看到的结果相关。是的,我在此视频的早期显示给您的CT扫描检查的那个人符合所有这些针对细胞因子风暴的标准,他入院后24小时就这样做了。
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