Santotoribio Jose D, Nuñez-Jurado David, Lepe-Balsalobre Esperanza
Clin Lab. 2020 Sep 1;66(9). doi: 10.7754/Clin.Lab.2020.200522.
Real-time reverse transcription polymerase chain reaction assay (RT-PCR) is the gold standard for diagnosis of coronavirus disease 2019 (COVID-19); however, it is not universally available and may have limitations in response times. The aim was to evaluate the routine blood tests for diagnosis of COVID-19, determining the diagnostic accuracy of blood biomarkers to differentiate between patients with and without COVID-19.
Clinical charts, nursing records, laboratory findings, and chest x-rays from adult patients with clinical suspicion of COVID-19 (fever, cough and/or dyspnea) at hospital admission were reviewed. Patients were classified into two groups according to RT-PCR COVID-19: positive (COVID-19) or negative (NON-COVID-19). Diagnostic accuracy was determined by analyzing receiver operating characteristic (ROC) curve, calculating the area under the ROC curve (AUC) and the cutoff value. In order to reduce the number of false positives, the cutoff value with a specificity of 80% was considered.
Two hundred three patients (101 females, 102 males) with ages between 18 and 96 years (mean = 61.3) were studied. Ninety-four were COVID-19 and 109 were NON-COVID-19. Plasma ferritin level was the most accurate biomarker (AUC = 0.847 and 0.804 in women and men, respectively). The following diagnostic criteria for suspected COVID-19 were established with biomarker cutoff values to differentiate between COVID-19 and NON-COVID-19 patients: lymphocytes ≤ 1.0 x 109/L; eosinophils ≤ 0.02 x 109/L; ferritin > 125% of upper reference limit (URL); LDH > 125% of URL; hsCRP > 80 mg/L; and D-dimer > 1.2 mg/L. Sensitivity was 66%, 64% 62%, 46%, 43%, and 33% for ferritin, eosinophils, LDH, hsCRP, lymphocytes, and D-dimer, respectively. Of those determined to be COVID-19 patients, 91% met one or more of the diagnostic criteria with these blood biomarkers, and of the NON-COVID-19 patients, 47% did not met any diagnostic criteria.
Blood counts of lymphocytes and eosinophils, and plasma levels of D-dimer, LDH, hsCRP, and ferritin can be used to differentiate patients with and without COVID-19 and as a tool for diagnosis of suspected COVID-19 in adult patients at hospital admission.
实时逆转录聚合酶链反应检测（RT-PCR）是诊断2019冠状病毒病（COVID-19）的金标准；然而，它并非普遍可用，且在响应时间上可能存在局限性。目的是评估用于诊断COVID-19的常规血液检查，确定血液生物标志物区分COVID-19患者和非COVID-19患者的诊断准确性。
回顾了成年患者入院时临床怀疑为COVID-19（发热、咳嗽和/或呼吸困难）的临床病历、护理记录、实验室检查结果和胸部X光片。根据RT-PCR检测结果将患者分为两组：阳性（COVID-19）或阴性（非COVID-19）。通过分析受试者工作特征（ROC）曲线、计算ROC曲线下面积（AUC）和临界值来确定诊断准确性。为了减少假阳性数量，考虑特异性为80%的临界值。
研究了203例年龄在18至96岁之间（平均 = 61.3岁）的患者（101例女性，102例男性）。94例为COVID-19患者，109例为非COVID-19患者。血浆铁蛋白水平是最准确的生物标志物（女性和男性的AUC分别为0.847和0.804）。建立了以下用于疑似COVID-19的诊断标准，采用生物标志物临界值来区分COVID-19患者和非COVID-19患者：淋巴细胞≤1.0×10⁹/L；嗜酸性粒细胞≤0.02×10⁹/L；铁蛋白>参考上限（URL）的125%；乳酸脱氢酶（LDH）>URL的125%；超敏C反应蛋白（hsCRP）>80mg/L；D-二聚体>1.2mg/L。铁蛋白、嗜酸性粒细胞、LDH、hsCRP、淋巴细胞和D-二聚体的敏感性分别为66%、64%、62%、46%、43%和33%。在被确定为COVID-19的患者中，91%符合这些血液生物标志物中的一项或多项诊断标准，而在非COVID-19患者中，47%不符合任何诊断标准。
淋巴细胞和嗜酸性粒细胞计数以及D-二聚体、LDH、hsCRP和铁蛋白的血浆水平可用于区分COVID-19患者和非COVID-19患者，并作为入院成年患者疑似COVID-19诊断的工具。
