Pascual Gómez N F, Monge Lobo I, Granero Cremades I, Figuerola Tejerina A, Ramasco Rueda F, von Wernitz Teleki A, Arrabal Campos F M, Sanz de Benito M A
Natalia F. Pascual Gómez, Servicio de Análisis clínicos. Hospital Universitario de la Princesa. C/Diego de León 62. CP: 28006. Madrid. 2ª Planta. Spain.
Rev Esp Quimioter. 2020 Aug;33(4):267-273. doi: 10.37201/req/060.2020. Epub 2020 Jul 13.
Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk.
Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score.
A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%).
Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.
确定首次急诊分析中检测的哪些生物标志物有助于根据死亡风险对新冠肺炎患者进行分层。
采用观察性、描述性和横断面研究，收集2020年2月24日至3月16日急诊科疑似新冠肺炎患者的数据。进行单变量和多变量研究以寻找独立的死亡标志物，并通过构建严重程度评分来计算风险。
共纳入163例患者，其中33例死亡，29例新冠肺炎PCR检测呈阳性。我们获得了构成死亡风险评分的可能因素，年龄>75岁（调整后OR = 12347，95%CI：4138 - 36845，p = 0.001）、总白细胞>11000个/mm³（调整后OR = 2649，95%CI：0.879 - 7.981，p = 0.083）、血糖>126mg/dL（调整后OR = 3.716，95%CI：1.247 - 11.074，p = 0.018）和肌酐>1.1mg/dL（调整后OR = 2.566，95%CI：0.889 - 7.403，p = 0.081）。该评分称为COVEB（新冠肺炎、年龄、基本分析指标），AUC为0.874（95%CI：0.816 - 0.933，p<0.001；截断点 = 1（敏感性 = 89.66%（95%CI：72.6% - 97.8%），特异性 = 75.59%（95%CI：67.2% - 82.8%））。评分<1时，阴性预测值 = 100%（95%CI：93.51% - 100%），阳性预测值 = 18.59%（95%CI：12.82% - 25.59%）。
临床严重程度量表、肾功能生物标志物、白细胞计数参数、中性粒细胞总数/淋巴细胞总数比值和降钙素原是死亡的早期危险因素。年龄、血糖、肌酐和总白细胞这些变量是死亡的最佳预测指标。COVEB评分<1表明疑似新冠肺炎患者在未来30天内死亡概率为0%。
