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首次急诊入院的 COVID-19 患者的实验室参数在非幸存者中有所不同:白蛋白和乳酸脱氢酶是危险因素。

Laboratory parameters in patients with COVID-19 on first emergency admission is different in non-survivors: albumin and lactate dehydrogenase as risk factors.

机构信息

Clinical Laboratory, Hospital Universitari San Juan de Alicante, Sant Joan d'Alacant, Spain

Department of Biochemistry and Molecular Pathology, Faculty of Medicine, Miguel Hernandez University of Elche, Sant Joan D'Alacant, Spain.

出版信息

J Clin Pathol. 2021 Oct;74(10):673-675. doi: 10.1136/jclinpath-2020-206865. Epub 2020 Oct 6.

Abstract

Prompt identification of the clinical status and severity of COVID-19 can be a challenge in the emergency department (ED), as the clinical severity of the disease is variable, real-time reverse-transcription PCR (RT-PCR) results may not be immediately available, and imaging findings appear approximately 10 days after the onset of symptoms. There is currently no set of simple, readily available and fast battery of tests that can be used in the ED as prognostic factors. The purpose was to study laboratory test results in patients with COVID-19 at hospital emergency admission and to evaluate the results in non-survivors and their potential prognostic value. A profile of laboratory markers was agreed with the ED providers based on the International Federation of Clinical Chemistry and Laboratory Medicine recommendation of its usefulness, which was made in 218 patients with COVID-19. Non-survivors were significantly older, and the percentage of patients with pathological values of creatinine, albumin, lactate dehydrogenase (LDH), C reactive protein, prothrombin time, D-dimer, and arterial blood gas, PaO/FIO and satO2/FIO indices were significantly higher among the patients with COVID-19 who died than those who survived. Patients who died also presented higher neutrophil counts. Among all studied tests, albumin and LDH were independent prognostic factors for death. The results of the study show pathology in nine laboratory markers in patients with COVID-19 admitted in the ED, valuable findings to take into consideration for its prompt identification when there is no immediate availability of RT-PCR results.

摘要

在急诊科 (ED),识别 COVID-19 的临床状态和严重程度可能具有挑战性,因为疾病的临床严重程度是可变的,实时逆转录聚合酶链反应 (RT-PCR) 结果可能无法立即获得,并且影像学表现大约在症状出现后 10 天出现。目前,ED 中没有一套简单、易于获得和快速的测试组合可作为预后因素。目的是研究 COVID-19 患者在医院急诊入院时的实验室检查结果,并评估非幸存者的结果及其潜在的预后价值。根据国际临床化学和实验室医学联合会基于其有用性的建议,与 ED 提供者达成了实验室标志物的特征,该建议适用于 218 名 COVID-19 患者。非幸存者年龄明显较大,且 COVID-19 死亡患者的肌酐、白蛋白、乳酸脱氢酶 (LDH)、C 反应蛋白、凝血酶原时间、D-二聚体、动脉血气、PaO/FIO 和 satO2/FIO 指数的病理值患者百分比显著高于存活患者。死亡患者的中性粒细胞计数也更高。在所有研究的测试中,白蛋白和 LDH 是死亡的独立预后因素。研究结果表明,ED 收治的 COVID-19 患者的九个实验室标志物存在病理学改变,在没有即时 RT-PCR 结果的情况下,这些有价值的发现有助于及时识别。

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