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COVID-19 住院患者的实验室检查的预后价值。

Prognostic value of labs ordered on patients hospitalized with COVID-19.

机构信息

Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

出版信息

Hosp Pract (1995). 2021 Apr;49(2):95-99. doi: 10.1080/21548331.2020.1863052. Epub 2020 Dec 29.

DOI:10.1080/21548331.2020.1863052
PMID:33306437
Abstract

: Hospitalists at our institution have taken on most non-intensive care unit (ICU) coronavirus disease 2019 (COVID-19) care. Based on sparse research, our institution developed a protocol for ordering labs for this patient population, including routine admission labs in addition to eight COVID-19-specific daily labs. The study goal is to determine if COVID-19-specific admission labs have any prognostic value beyond that provided by routine admission labs and vitals, and costs of labs with no prognostic value.: We retrospectively reviewed adult patients admitted with COVID-19 from 3/2020 to 7/2020. Outcomes were mortality, ICU stay, and length of hospitalization. Multivariable logistic and linear regression were used to determine if COVID-19-specific admission labs have any prognostic value beyond that provided by vitals and routine admission labs. COVID-19-specific labs were d-Dimer, fibrinogen, ferritin, LDH, CK, pro-BNP, troponin, and CRP. Multivariable models included all routine admission labs and vitals. COVID-19-specific admission labs were included in the multivariable models if the p-value was <0.05 in the univariable analysis.: 331 patients met study criteria, inpatient mortality was 13.0%, 52.4% of patients required ICU stays and the average length of hospitalization was 8.9 days. COVID-19-specific labs showed no additional prognostic value for mortality. CRP, LDH, and d-Dimer provided additional prognostic information for ICU stay. CRP≥100 mg/dL and LDH≥900 U/L were associated with increased length of hospitalization.: Only 3 of 8 admission COVID-19-specific labs recommended by our institution's protocol had additional prognostic value beyond that provided by routine labs and vitals. The total cost of non-prognostic COVID-19-specific labs during the study period was $75,874.

摘要

: 我们医院的住院医师承担了大多数非重症监护病房(ICU)的 2019 年冠状病毒病(COVID-19)的护理工作。根据有限的研究,我们医院为该患者群体制定了实验室检测方案,包括常规入院实验室检查,以及八项 COVID-19 特定的每日实验室检查。本研究的目的是确定 COVID-19 特定的入院实验室检查除了常规入院实验室检查和生命体征之外是否具有预后价值,以及没有预后价值的实验室检查的成本。

: 我们回顾性地审查了 2020 年 3 月至 2020 年 7 月因 COVID-19 入院的成年患者。结局为死亡率、入住 ICU 和住院时间。多变量逻辑和线性回归用于确定 COVID-19 特定的入院实验室检查除了生命体征和常规入院实验室检查之外是否具有预后价值。COVID-19 特定的实验室检查包括 D-二聚体、纤维蛋白原、铁蛋白、乳酸脱氢酶、肌酸激酶、脑钠肽前体、肌钙蛋白和 C 反应蛋白。多变量模型包括所有常规入院实验室检查和生命体征。如果在单变量分析中 p 值<0.05,则将 COVID-19 特定的入院实验室检查纳入多变量模型。

: 331 名患者符合研究标准,住院死亡率为 13.0%,52.4%的患者需要入住 ICU,平均住院时间为 8.9 天。COVID-19 特定的实验室检查对死亡率没有额外的预后价值。CRP、LDH 和 D-二聚体为 ICU 入住提供了额外的预后信息。CRP≥100mg/dL 和 LDH≥900U/L 与住院时间延长有关。

: 在我们医院的方案中,建议的 8 项 COVID-19 特定入院实验室检查中,只有 3 项具有除常规实验室检查和生命体征之外的额外预后价值。在研究期间,非预后 COVID-19 特定实验室检查的总费用为 75874 美元。

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