铁蛋白与降钙素原比值在鉴别新冠肺炎患者与细菌性肺炎患者中的诊断价值：一项多中心研究
Diagnostic Utility of a Ferritin-to-Procalcitonin Ratio to Differentiate Patients With COVID-19 From Those With Bacterial Pneumonia: A Multicenter Study.
作者信息
Gharamti Amal A, Mei Fei, Jankousky Katherine C, Huang Jin, Hyson Peter, Chastain Daniel B, Fan Jiawei, Osae Sharmon, Zhang Wayne W, Montoya José G, Erlandson Kristine M, Scherger Sias J, Franco-Paredes Carlos, Henao-Martínez Andrés F, Shapiro Leland
机构信息
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Department of Vascular Surgery, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China.
出版信息
Open Forum Infect Dis. 2021 Mar 14;8(6):ofab124. doi: 10.1093/ofid/ofab124. eCollection 2021 Jun.
BACKGROUND
There is an urgent need for accurate, rapid, inexpensive biomarkers that can differentiate coronavirus disease 2019 (COVID-19) from bacterial pneumonia. We assess the role of the ferritin-to-procalcitonin (F/P) ratio to classify pneumonia cases into those due to COVID-19 vs those due to bacterial pathogens.
METHODS
This multicenter case-control study compared patients with COVID-19 with those with bacterial pneumonia, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection were excluded. The F/P in patients with COVID-19 vs with bacterial pneumonia were compared. Receiver operating characteristic curve analysis determined the sensitivity and specificity of various cutoff F/P values for COVID-19 vs bacterial pneumonia.
RESULTS
A total of 242 COVID-19 pneumonia cases and 34 bacterial pneumonia controls were included. Patients with COVID-19 pneumonia had a lower mean age (57.1 vs 64.4 years; = .02) and a higher body mass index (30.74 vs 27.15 kg/m; = .02) compared with patients with bacterial pneumonia. Cases and controls had a similar proportion of women (47% vs 53%; = .5), and COVID-19 patients had a higher prevalence of diabetes mellitus (32.6% vs 12%; = .01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared with the F/P in bacterial pneumonia (802; < .001). An F/P ≥877, used to diagnose COVID-19, resulted in a sensitivity of 85% and a specificity of 56%, with a positive predictive value of 93.2% and a likelihood ratio of 1.92. In multivariable analyses, an F/P ≥877 was associated with greater odds of identifying a COVID-19 case (odds ratio, 11.27; 95% CI, 4-31.2; < .001).
CONCLUSIONS
An F/P ≥877 increases the likelihood of COVID-19 pneumonia compared with bacterial pneumonia.
背景
迫切需要准确、快速且廉价的生物标志物，以区分2019冠状病毒病（COVID-19）和细菌性肺炎。我们评估铁蛋白与降钙素原（F/P）比值在将肺炎病例分类为COVID-19所致与细菌病原体所致方面的作用。
方法
这项多中心病例对照研究比较了2020年3月1日至5月31日期间收治的COVID-19患者和细菌性肺炎患者。排除COVID-19和细菌性肺炎合并感染的患者。比较了COVID-19患者与细菌性肺炎患者的F/P比值。通过受试者工作特征曲线分析确定了不同F/P临界值对COVID-19与细菌性肺炎的敏感性和特异性。
结果
共纳入242例COVID-19肺炎病例和34例细菌性肺炎对照。与细菌性肺炎患者相比，COVID-19肺炎患者的平均年龄较低（57.1岁对64.4岁；P = 0.02），体重指数较高（30.74对27.15 kg/m²；P = 0.02）。病例组和对照组女性比例相似（47%对53%；P = 0.5），COVID-19患者糖尿病患病率较高（32.6%对12%；P = 0.01）。COVID-19患者的F/P中位数（4037.5）显著高于细菌性肺炎患者的F/P（802；P < 0.001）。用于诊断COVID-19的F/P≥877，敏感性为85%，特异性为56%，阳性预测值为93.2%，似然比为1.92。在多变量分析中，F/P≥877与识别COVID-19病例的可能性增加相关（比值比，11.27；95%置信区间，4 - 31.2；P < 0.001）。
结论
与细菌性肺炎相比，F/P≥877增加了COVID-19肺炎的可能性。
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