Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA.
Harvard Medical School, Boston, MA 02115, USA.
Cell Rep Med. 2020 Nov 17;1(8):100144. doi: 10.1016/j.xcrm.2020.100144. Epub 2020 Oct 29.
In this single-center, retrospective cohort analysis of hospitalized coronavirus disease 2019 (COVID-19) patients, we investigate whether inflammatory biomarker levels predict respiratory decline in patients who initially present with stable disease. Examination of C-reactive protein (CRP) trends reveals that a rapid rise in CRP levels precedes respiratory deterioration and intubation, although CRP levels plateau in patients who remain stable. Increasing CRP during the first 48 h of hospitalization is a better predictor (with higher sensitivity) of respiratory decline than initial CRP levels or ROX indices (a physiological score of respiratory function). CRP, the proinflammatory cytokine interleukin-6 (IL-6), and physiological measures of hypoxemic respiratory failure are correlated, which suggests a mechanistic link. Our work shows that rising CRP predicts subsequent respiratory deterioration in COVID-19 and may suggest mechanistic insight and a potential role for targeted immunomodulation in a subset of patients early during hospitalization.
在这项针对住院的 2019 冠状病毒病（COVID-19）患者的单中心回顾性队列分析中，我们研究了炎症生物标志物水平是否可以预测初始表现为稳定疾病的患者的呼吸下降。检查 C 反应蛋白（CRP）趋势表明，CRP 水平的快速升高先于呼吸恶化和插管，尽管 CRP 水平在保持稳定的患者中趋于平稳。在住院的前 48 小时内，CRP 的增加（具有更高的敏感性）是呼吸下降的更好预测指标，优于初始 CRP 水平或 ROX 指数（呼吸功能的生理评分）。CRP、促炎细胞因子白细胞介素 6（IL-6）和低氧性呼吸衰竭的生理指标相关，这表明存在一种机制联系。我们的工作表明，CRP 的升高预示着 COVID-19 患者随后的呼吸恶化，这可能提示了机制上的见解，以及在住院早期对一部分患者进行靶向免疫调节的潜在作用。
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