Subramanian Kritika, Brandeis Gary
Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, USA.
Cureus. 2021 Oct 6;13(10):e18532. doi: 10.7759/cureus.18532. eCollection 2021 Oct.
Background Much effort has been placed on evaluating serological tests that can predict worsening prognosis in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Endotracheal intubation in SARS-CoV-2 is associated with a higher risk of mortality. While studies have evaluated serological markers that can predict worsening prognosis, the likelihood of intubation in these patients has not been evaluated. The objective of this study was to determine if any serum marker corresponded to oxygen escalation or de-escalation in SARS-CoV-2-infected pre-intubated patients. Methodology This retrospective study reviewed 1,754 SARS-CoV-2 patients in the New York City Health and Hospitals Corporation (NYCHHC) system who required non-invasive positive pressure ventilation (NIPPV) such as continuous positive airway pressure or bilevel positive airway pressure. All patients were above the age of 18, were not terminally ill and requiring hospice care, and were admitted to the NYCHHC system between March 1, 2020 and May 17, 2020. SARS-CoV-2 serological labs were collected for five days for patients initiated on NIPPV, such that day one was 24 hours after NIPPV initiation. Results Multivariate and univariate linear regression modeling on this population cohort was remarkable for a significant association between serum albumin levels and oxygen escalation or de-escalation from NIPPV. Conclusions We conclude that serum albumin level may have further utility in predicting oxygen escalation in pre-intubated patients with SARS-CoV-2, especially in a low-resource and high-demand setting.
人们已付出诸多努力来评估可预测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染预后恶化的血清学检测方法。SARS-CoV-2患者进行气管插管与更高的死亡风险相关。虽然已有研究评估了可预测预后恶化的血清学标志物，但尚未评估这些患者进行插管的可能性。本研究的目的是确定在SARS-CoV-2感染的插管前患者中，是否有任何血清标志物与吸氧升级或降级相对应。方法：这项回顾性研究对纽约市卫生与医院系统（NYCHHC）中1754例需要无创正压通气（NIPPV）（如持续气道正压通气或双水平气道正压通气）的SARS-CoV-2患者进行了回顾。所有患者年龄均在18岁以上，非终末期疾病且无需临终关怀，并于2020年3月1日至2020年5月17日期间入住NYCHHC系统。对开始使用NIPPV的患者连续5天采集SARS-CoV-2血清学实验室检测样本，第一天为开始使用NIPPV后24小时。结果：对该人群队列进行多变量和单变量线性回归建模发现，血清白蛋白水平与NIPPV吸氧升级或降级之间存在显著关联。结论：我们得出结论，血清白蛋白水平在预测SARS-CoV-感染者插管前吸氧升级方面可能具有进一步的作用，尤其是在资源匮乏且需求高的情况下。
