Guo Wei, Ran Lin-Yu, Zhu Ji-Hong, Ge Qing-Gang, Du Zhe, Wang Fei-Long, Gao Wei-Bo, Wang Tian-Bing
Trauma Center, Peking University People's Hospital, Beijing 100044, China.
Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai 200120, China.
World J Emerg Med. 2021;12(1):18-23. doi: 10.5847/wjem.j.1920-8642.2021.01.003.
A pandemic of coronavirus disease (COVID-19) has been declared by the World Health Organization (WHO) and caring for critically ill patients is expected to be at the core of battling this disease. However, little is known regarding an early detection of patients at high risk of fatality.
This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29, 2020, to the three intensive care units (ICUs) in a designated hospital for treating COVID-19 in Wuhan. The detailed clinical information and laboratory results for each patient were obtained. The primary outcome was in-hospital mortality. Potential predictors were analyzed for possible association with outcomes, and the predictive performance of indicators was assessed from the receiver operating characteristic (ROC) curve.
A total of 121 critically ill patients were included in the study, and 28.9% (35/121) of them died in the hospital. The non-survivors were older and more likely to develop acute organ dysfunction, and had higher Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores. Among the laboratory variables on admission, we identified 12 useful biomarkers for the prediction of in-hospital mortality, as suggested by area under the curve (AUC) above 0.80. The AUCs for three markers neutrophil-to-lymphocyte ratio (NLR), thyroid hormones free triiodothyronine (FT3), and ferritin were 0.857, 0.863, and 0.827, respectively. The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality (0.901 vs. 0.955, =0.085).
Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients. Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.
世界卫生组织（WHO）已宣布冠状病毒病（COVID-19）大流行，救治重症患者预计是抗击该疾病的核心。然而，对于早期发现高死亡风险患者却知之甚少。
这项回顾性队列研究纳入了2020年2月8日至2月29日期间连续收治到武汉一家指定的COVID-19治疗医院的三个重症监护病房（ICU）的成年患者。获取了每位患者的详细临床信息和实验室检查结果。主要结局是院内死亡率。分析潜在预测因素与结局之间可能的关联，并从受试者工作特征（ROC）曲线评估指标的预测性能。
该研究共纳入121例重症患者，其中28.9%（35/121）在医院死亡。未存活者年龄更大，更易发生急性器官功能障碍，序贯器官衰竭评估（SOFA）和快速SOFA（qSOFA）评分更高。在入院时的实验室变量中，我们确定了12种有助于预测院内死亡率的生物标志物，曲线下面积（AUC）大于0.80表明其具有预测价值。中性粒细胞与淋巴细胞比值（NLR）、甲状腺激素游离三碘甲状腺原氨酸（FT3）和铁蛋白这三种标志物的AUC分别为0.857、0.863和0.827。NLR和铁蛋白这两个易于获取的变量相结合，在预测院内死亡率方面与SOFA评分具有相当的AUC（0.901对0.955，P = 0.085）。
急性器官功能障碍合并高龄与COVID-19患者的致命结局相关。循环生物标志物可作为院内死亡率的有力预测指标。
