Topp Gregory, Bouyea Megan, Cochran-Caggiano Nicholas, Ata Ashar, Torres Pedro, Jacob Jackcy, Wales Danielle
Department of Medicine, Albany Medical College, Albany, USA.
Department of Surgery, Albany Medical Center, Albany, USA.
Cureus. 2021 Jun 5;13(6):e15462. doi: 10.7759/cureus.15462. eCollection 2021 Jun.
Purpose Many patients with COVID-19 who develop acute respiratory distress syndrome (ARDS) require prolonged periods of mechanical ventilation. Mechanical ventilation may amplify ventilator-associated complications and extend resource utilization. A better understanding of prognostic indicators could help in the planning and distribution of resources, particularly in resource-limited areas. We analyzed laboratory studies of intubated COVID-19 patients with the goal of identifying biomarkers that may predict extubation success and survival to discharge. Methods A retrospective chart review was performed on all COVID-19 patients requiring mechanical ventilation between January 3, 2020, and January 7, 2020, in a single academic tertiary care center in Northeastern New York State. The electronic medical record was used to collect 14 laboratory variables at three time points: admission, intubation, and extubation (including terminal extubation) for all intubated intensive care unit (ICU) patients treated for COVID-19. Mean laboratory values were analyzed with the Mann-Whitney U test. Categorical variables were analyzed with the two-sample Wilcoxon rank-sum test. Results Seventy-two patients met the inclusion criteria. Forty-three patients were male. The mean age was 61 years. The overall mortality was 50%. On admission, intubated patients who survived had significantly higher platelet counts (p=0.024), and absolute lymphocyte counts (ALC; p=0.047). Notably, ferritin (p=0.018) and aspartate transaminase (AST; p=0.0045) levels were lower in survivors. At the time of intubation, survivors again had a higher platelet count (p=0.024) and ALC (p=0.037) levels. They had a lower D-dimer (p=0.0014), ferritin (p=0.0015), lactate dehydrogenase (LDH; p=0.0145), and AST (p=0.018) compared to intubated patients who died. At extubation, survivors had higher platelet count (p=0.0002), ALC (p=0.0013), and neutrophil/lymphocyte ratio (NLR; p=0.0024). Survivors had lower d-dimer (p=0.035), ferritin (p=0.0012), CRP (p=0.045), LDH (p=0.002), AST (p<0.001), and ALK (p=0.0048). Conclusions Biomarkers associated with increased risk of mortality include platelet count, ALC, lymphocyte percentage, NLR, D-dimer, ferritin, C-reactive protein (CRP), AST, alanine transaminase (ALT), and alkaline phosphatase (ALK). This study provides additional evidence that these biomarkers have prognostic value in patients with severe COVID-19. The goal is to find objective surrogate markers of disease improvement or success of extubation. When considered within the larger body of data, it is our hope that a mortality risk calculator can be generated for intubated COVID-19 patients.
目的 许多感染新型冠状病毒肺炎（COVID-19）并发展为急性呼吸窘迫综合征（ARDS）的患者需要长时间机械通气。机械通气可能会增加呼吸机相关并发症并延长资源利用时间。更好地了解预后指标有助于资源的规划和分配，尤其是在资源有限的地区。我们分析了插管COVID-19患者的实验室研究，目的是确定可能预测拔管成功和出院存活的生物标志物。方法 对2020年1月3日至2020年1月7日期间在纽约州东北部一家学术性三级医疗中心接受机械通气的所有COVID-19患者进行回顾性病历审查。使用电子病历收集所有接受COVID-19治疗的插管重症监护病房（ICU）患者在三个时间点（入院、插管和拔管（包括终末拔管））的14项实验室变量。使用Mann-Whitney U检验分析平均实验室值。使用两样本Wilcoxon秩和检验分析分类变量。结果 72例患者符合纳入标准。43例患者为男性。平均年龄为61岁。总体死亡率为50%。入院时，存活的插管患者血小板计数（p=0.024）和绝对淋巴细胞计数（ALC；p=0.047）显著更高。值得注意的是，存活者的铁蛋白（p=0.018）和天冬氨酸转氨酶（AST；p=0.0045）水平较低。在插管时，存活者的血小板计数（p=0.024）和ALC（p=0.037）水平再次较高。与死亡的插管患者相比，他们的D-二聚体（p=0.0014）、铁蛋白（p=0.0015）、乳酸脱氢酶（LDH；p=0.0145）和AST（p=0.018）较低。在拔管时，存活者的血小板计数（p=0.0002）、ALC（p=0.0013）和中性粒细胞/淋巴细胞比值（NLR；p=0.0024）较高。存活者的D-二聚体（p=0.035）、铁蛋白（p=0.0012）、C反应蛋白（CRP；p=0.045）、LDH（p=0.002）、AST（p<0.001）和碱性磷酸酶（ALK；p=0.0048）较低。结论 与死亡风险增加相关的生物标志物包括血小板计数、ALC、淋巴细胞百分比、NLR、D-二聚体、铁蛋白、C反应蛋白（CRP）、AST、丙氨酸转氨酶（ALT）和碱性磷酸酶（ALK）。本研究提供了额外证据，表明这些生物标志物在重症COVID-19患者中具有预后价值。目标是找到疾病改善或拔管成功的客观替代标志物。在更大量的数据中进行考虑时，我们希望能够为插管COVID-19患者生成一个死亡风险计算器。
