Aston University, Birmingham, UK.
Department of Haematology, Sandwell and West Birmingham Hospitals, NHS Trust, West Bromwich, UK.
Int J Lab Hematol. 2021 Oct;43(5):1243-1251. doi: 10.1111/ijlh.13538. Epub 2021 May 3.
Although factors such as age, sex, diabetes, obesity and changes in certain laboratory investigations are important prognostic factors in COVID-19 infection, these may not apply to all ethnic/racial groups. We hypothesized differences in routine biochemistry and haematology indices in Caucasian and a combined group of Black, Asian and Minority Ethnic (BAME) patients who tested positive for COVID-19 who died, compared to survivors.
We tested our hypothesis in 445 patients (229 Caucasian, 216 BAME) admitted to secondary care with proven COVID-19 infection, in whom standard routine laboratory indices were collected on admission.
After 28 weeks, 190 (42.7%) had died within 28 days of COVID diagnosis (97 Caucasians [42.4%], 93 BAMEs [43.1%], P = .923). A general linear model analysis found the ethnicity interaction with mortality to be significant for fibrinogen, ferritin and HbA c (after controlling for age). In a multivariate analysis, a neutrophil/lymphocyte ratio > 7.4 and a urea/albumin ratio > 0.28 increased the odds of death for both the Caucasian and the BAME group. Additional factors increasing the odds ratio in the BAME group included age >60 years and being diabetic.
Neutrophil/lymphocyte ratio and urea/albumin ratio are simple metrics that predict death to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce mortality. In the BAME groups, intensive monitoring even at younger age and those with diabetes may also help reduce COVID-19 associated mortality.
尽管年龄、性别、糖尿病、肥胖和某些实验室检查的变化等因素是 COVID-19 感染的重要预后因素,但这些因素可能不适用于所有种族/民族群体。我们假设,在因 COVID-19 检测呈阳性而死亡的白人和黑种人、亚洲人和少数族裔(BAME)患者以及幸存者中,常规生化和血液学指标存在差异。
我们在 445 名因确诊 COVID-19 而住院的二级护理患者(229 名白人,216 名 BAME)中测试了我们的假设,这些患者入院时采集了标准常规实验室指标。
28 周后,190 人(42.7%)在 COVID 诊断后 28 天内死亡(97 名白人[42.4%],93 名 BAME [43.1%],P=0.923)。一般线性模型分析发现,在控制年龄后,种族与死亡率的相互作用对纤维蛋白原、铁蛋白和 HbA c 具有统计学意义。在多变量分析中,中性粒细胞/淋巴细胞比值>7.4 和尿素/白蛋白比值>0.28 增加了白人和 BAME 两组的死亡风险。在 BAME 组中,增加比值比的其他因素包括年龄>60 岁和患有糖尿病。
中性粒细胞/淋巴细胞比值和尿素/白蛋白比值是预测死亡的简单指标,可以帮助临床医生确定 COVID-19 的预后,并有助于提供早期强化干预以降低死亡率。在 BAME 组中,即使在年龄较小和患有糖尿病的患者中,也需要加强监测,以帮助降低 COVID-19 相关死亡率。