Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA; Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA.
Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA; Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA.
Am J Emerg Med. 2021 Aug;46:595-598. doi: 10.1016/j.ajem.2020.11.038. Epub 2020 Nov 24.
Inflammatory markers are often elevated in patients with COVID-19. The objective of this study is to assess the prognostic capability of these tests in predicting clinical outcomes.
This was a retrospective cohort study including all patients at least 16 years old with COVID-19 who were admitted from one of five Emergency Departments between March 6th and April 4th, 2020. We included 1123 laboratory-confirmed cases of COVID-19. We analyzed white blood cell count (WBC), absolute lymphocyte count (ALC), lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, ferritin, and erythrocyte sedimentation rate (ESR). We looked at clinical outcomes including death, the need for endotracheal intubation (ETT), the need for renal replacement therapy (RRT), and ICU admission. We report Spearman's ρ and statistical significance for each correlation with outcomes. We also report positive predictive value, negative predictive value, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios.
The mean age of our patient population was 62 (SD 16). Thirty-seven percent of patients self-reported Spanish/Hispanic/Latino ethnicity, 47% reported their race as Black or African-American, and 10% reported their race as non-Hispanic white. Inter-rater reliability was 96%. There was no laboratory value that had both sensitivity and specificity of at least 0.90, or that had a positive predictive value and negative predictive value of at least 0.90, or that had likelihood ratios that could reliably predict a severe course of disease.
Inflammatory markers drawn within 48 h of arrival, though often correlated with clinical outcomes, are not individually highly predictive of which patients in a predominantly older and minority population will die or require intubation, RRT, or ICU admission.
COVID-19 患者的炎症标志物通常升高。本研究旨在评估这些检测在预测临床结局方面的预后能力。
这是一项回顾性队列研究，纳入 2020 年 3 月 6 日至 4 月 4 日期间从五个急诊科之一入院的至少 16 岁患有 COVID-19 的患者。共纳入 1123 例实验室确诊的 COVID-19 病例。我们分析了白细胞计数（WBC）、绝对淋巴细胞计数（ALC）、乳酸脱氢酶（LDH）、C 反应蛋白（CRP）、降钙素原（PCT）、D-二聚体、铁蛋白和红细胞沉降率（ESR）。我们观察了临床结局，包括死亡、需要气管插管（ETT）、需要肾脏替代治疗（RRT）和 ICU 入院。我们报告了与结局的相关性的 Spearman's ρ 和统计学意义。我们还报告了阳性预测值、阴性预测值、敏感性、特异性、阳性似然比和阴性似然比。
患者人群的平均年龄为 62（标准差 16）岁。37%的患者自报西班牙裔/拉丁裔/拉丁裔，47%报告其种族为黑人和非裔美国人，10%报告其种族为非西班牙裔白人。观察者间可靠性为 96%。没有任何实验室值的敏感性和特异性均至少为 0.90，或阳性预测值和阴性预测值均至少为 0.90，或似然比能够可靠地预测疾病的严重程度。
在入院后 48 小时内抽取的炎症标志物虽然常与临床结局相关，但不能单独预测主要为老年和少数族裔人群中哪些患者会死亡或需要插管、RRT 或 ICU 入院。
