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我们能否预测 COVID-19 疾病的预后?

Could we predict the prognosis of the COVID-19 disease?

机构信息

Department of Clinical Microbiology and Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Department of Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

出版信息

J Med Virol. 2021 Apr;93(4):2420-2430. doi: 10.1002/jmv.26751. Epub 2021 Jan 5.

Abstract

OBJECTIVES

Coronavirus 2019 disease (COVID-19) lead to one of the pandemics of the last century. We aimed to predict poor prognosis among severe patients to lead early intervention.

METHODS

The data of 534 hospitalized patients were assessed retrospectively. Risk factors and laboratory tests that might enable the prediction of prognosis defined as being transferred to the intensive care unit and/or exitus have been investigated.

RESULTS

At the admission, 398 of 534 patients (74.5%) were mild-moderate ill. It was determined that the male gender, advanced age, and comorbidity were risk factors for severity. To estimate the severity of the disease, receiver operating characteristic analysis revealed that the areas under the curve which were determined based on the optimal cut off values that were calculated for the variables of values of neutrophil to lymphocyte ratio (NLR > 3.69), C-reactive protein (CRP > 46 mg/L), troponin I ( > 5.3 ng/L), lactate dehydrogenase (LDH > 325 U/L), ferritin ( > 303 ug/L), d-dimer ( > 574 μg/L), neutrophil NE ( > 4.99 × 10 /L), lymphocyte (LE < 1.04 × 10 /L), SO ( < %92) were 0.762, 0.757,0.742, 0.705, 0.698, 0.694,0.688, 0.678, and 0.66, respectively. To predict mortality, AUC of values for optimal cutoff troponin I ( > 7.4 ng/L), age ( > 62), SO ( < %89), urea ( > 40 mg/dL), procalcitonin ( > 0.21 ug/L), CKMB ( > 2.6 ng/L) were 0.715, 0.685, 0.644, 0.632, 0.627, and 0.617, respectively.

CONCLUSIONS

The clinical progress could be severe if the baseline values of NLR, CRP, troponin I, LDH, are above, and LE is below the specified cut-off point. We found that the troponin I, elder age, and SO values could predict mortality.

摘要

目的

2019 年冠状病毒病(COVID-19)导致了上个世纪的一次大流行之一。我们旨在预测重症患者的不良预后,以便进行早期干预。

方法

回顾性评估了 534 名住院患者的数据。调查了可能预测预后(定义为转至重症监护病房和/或死亡)的预后定义的危险因素和实验室检查。

结果

在入院时,534 例患者中有 398 例(74.5%)为轻度至中度疾病。确定男性,高龄和合并症是严重程度的危险因素。为了估计疾病的严重程度,接受者操作特征分析表明,基于计算出的中性粒细胞与淋巴细胞比值(NLR>3.69),C-反应蛋白(CRP>46mg/L),肌钙蛋白 I(>5.3ng/L),乳酸脱氢酶(LDH>325U/L),铁蛋白(>303μg/L),D-二聚体(>574μg/L),中性粒细胞 NE(>4.99×10 / L),淋巴细胞(LE<1.04×10 / L),SO(<92%)的最佳截断值变量确定的曲线下面积分别为 0.762、0.757、0.742、0.705、0.698、0.694、0.688、0.678 和 0.66。为了预测死亡率,最佳截断值肌钙蛋白 I(>7.4ng/L),年龄(>62),SO(<89%),尿素(>40mg/dL),降钙素原(>0.21μg/L),肌酸激酶同工酶 MB(>2.6ng/L)的 AUC 值分别为 0.715、0.685、0.644、0.632、0.627 和 0.617。

结论

如果 NLR、CRP、肌钙蛋白 I、LDH 的基线值高于指定的截断值,而 LE 值低于指定的截断值,则临床进展可能会很严重。我们发现肌钙蛋白 I、年龄较大和 SO 值可预测死亡率。

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