Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, ON, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Clin Biochem. 2021 Sep;95:41-48. doi: 10.1016/j.clinbiochem.2021.05.008. Epub 2021 May 19.
Coronavirus Disease 2019 (COVID-19) has variable clinical presentation, from asymptomatic to severe disease leading to death. Biochemical markers may help with management and prognostication of COVID-19 patients; however, their utility is still under investigation.
A retrospective study was conducted to evaluate alanine aminotransferase, C-reactive protein (CRP), ferritin, lactate, and high sensitivity troponin T (TnT) levels in 67 patients who were admitted to a Canadian tertiary care centre for management of COVID-19. Logistic, cause-specific Cox proportional-hazards, and accelerated failure time regression modelling were performed to assess the associations of initial analyte concentrations with in-hospital death and length of stay in hospital; joint modelling was performed to assess the associations of the concentrations over the course of the hospital stay with in-hospital death.
Initial TnT and CRP concentrations were associated with length of stay in hospital. Eighteen patients died (27%), and the median initial TnT concentration was higher in patients who died (55 ng/L) than those who lived (16 ng/L; P < 0.0001). There were no survivors with an initial TnT concentration > 64 ng/L. While the initial TnT concentration was predictive of death, later measurements were not. Only CRP had prognostic value with both the initial and subsequent measurements: a 20% increase in the initial CRP concentration was associated with a 14% (95% confidence interval (CI): 1-29%) increase in the odds of death, and the hazard of death increased 14% (95% CI: 5-25%) for each 20% increase in the current CRP value. While the initial lactate concentration was not predictive of death, subsequent measurements were.
CRP, lactate and TnT were associated with poorer outcomes and appear to be useful biochemical markers for monitoring COVID-19 patients.
2019 年冠状病毒病（COVID-19）的临床表现各不相同，从无症状到导致死亡的重症疾病。生化标志物可能有助于管理和预测 COVID-19 患者；然而，它们的效用仍在研究中。
对在加拿大一家三级护理中心接受 COVID-19 治疗的 67 例患者的丙氨酸氨基转移酶、C 反应蛋白（CRP）、铁蛋白、乳酸和高敏肌钙蛋白 T（TnT）水平进行回顾性研究。进行逻辑回归、特定原因 Cox 比例风险和加速失效时间回归模型分析，以评估初始分析物浓度与住院期间死亡和住院时间的关系；联合模型用于评估住院期间浓度的变化与住院期间死亡的关系。
初始 TnT 和 CRP 浓度与住院时间有关。18 例患者死亡（27%），死亡患者的初始 TnT 浓度中位数（55ng/L）高于存活患者（16ng/L；P<0.0001）。没有初始 TnT 浓度>64ng/L 的幸存者。虽然初始 TnT 浓度可预测死亡，但后续测量值则不能。只有 CRP 具有初始和后续测量值的预后价值：初始 CRP 浓度增加 20%，死亡的几率增加 14%（95%置信区间（CI）：1-29%），当前 CRP 值增加 20%，死亡的风险增加 14%（95%CI：5-25%）。初始乳酸浓度与死亡无关，但随后的测量值则与死亡有关。
CRP、乳酸和 TnT 与较差的预后相关，似乎是监测 COVID-19 患者的有用生化标志物。
