Chen Meiqiao, Wu Yuanbo, Jia Wei, Yin Ming, Hu Zhe, Wang Rui, Li Wenting, Wang Guoping
Department of Neurology, Anhui Provincial Hospital, Anhui Medical University Hefei 230001, Anhui Province, China.
Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China Hefei 230001, Anhui Province, China.
Am J Transl Res. 2020 Aug 15;12(8):4569-4575. eCollection 2020.
This study was designed to assess the levels of human serum amyloid A (SAA) and C-reactive protein (CRP) in patients with coronavirus disease 2019 (COVID-19) to determine their prognostic value in predicting the severity of disease. Patients with COVID-19 who presented with acute respiratory distress syndrome (ARDS) shared distinct characteristics. For example, the patients were older, and had higher levels of inflammatory indicators [i.e., levels of CRP, SAA, procalcitonin (PCT), and interleukin-6; CRP-to-PCT ratio; SAA-to-CRP ratio; and neutrophil-to-lymphocyte ratio (NLR)], higher inflammatory cell counts (i.e., white blood cell count and neutrophil count), and lower lymphocyte counts compared with patients without ARDS. Patients without ARDS still exhibited mild illness and had elevated SAA levels but not CRP levels. In patients with elevated SAA and CRP levels, the NLR was statistically associated with disease severity. According to the receiver operating characteristic curve analysis, the combined predictive probability of CRP and SAA levels, along with white blood cell count, showed the highest area under the curve (AUC; 0.878), and was able to distinguish between patients with and without ARDS. The cut-off level for SAA to predict the severity of COVID-19 was 92.900, with a sensitivity of 95.8%, a specificity of 53.7%, and an AUC of 0.712. For patients with elevated levels of SAA but not CRP, a mild condition was predicted. For patients with elevated levels of both SAA and CRP, and a high NLR, a severe infection was predicted, requiring medical attention. Therefore, CRP and SAA levels demonstrate a prognostic value for predicting the severity of COVID-19.
本研究旨在评估2019冠状病毒病（COVID-19）患者的血清淀粉样蛋白A（SAA）和C反应蛋白（CRP）水平，以确定其在预测疾病严重程度方面的预后价值。出现急性呼吸窘迫综合征（ARDS）的COVID-19患者具有明显的特征。例如，与未发生ARDS的患者相比，这些患者年龄较大，炎症指标水平更高[即CRP、SAA、降钙素原（PCT）和白细胞介素-6水平；CRP与PCT的比值；SAA与CRP的比值；以及中性粒细胞与淋巴细胞比值（NLR）]，炎症细胞计数更高（即白细胞计数和中性粒细胞计数），淋巴细胞计数更低。未发生ARDS的患者仍表现为轻症，SAA水平升高但CRP水平未升高。在SAA和CRP水平升高的患者中，NLR与疾病严重程度具有统计学相关性。根据受试者工作特征曲线分析，CRP和SAA水平以及白细胞计数的联合预测概率显示曲线下面积（AUC）最高（0.878），并且能够区分发生和未发生ARDS的患者。预测COVID-19严重程度的SAA临界值为92.900，灵敏度为95.8%，特异性为53.7%，AUC为0.712。对于SAA水平升高但CRP水平未升高的患者，预测为轻症。对于SAA和CRP水平均升高且NLR较高的患者，预测为严重感染，需要医疗关注。因此，CRP和SAA水平在预测COVID-19严重程度方面具有预后价值。
