Parimoo Aditi, Biswas Ashutosh, Baitha Upendra, Gupta Gaurav, Pandey Shivam, Ranjan Piyush, Gupta Vandana, Barman Roy Debarchan, Prakash Bindoo, Wig Naveet
Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, IND.
Cureus. 2021 Oct 27;13(10):e19080. doi: 10.7759/cureus.19080. eCollection 2021 Oct.
Introduction A cytokine storm is an important cause of morbidity and mortality in patients with coronavirus disease 2019 (COVID-19). The objective of the study was to determine the prognostic significance of pro-inflammatory cytokines with the overall final outcome of patients with COVID-19. Methods We conducted a retrospective study of 142 patients admitted with COVID-19 in the Department of Medicine at All India Institute of Medical Sciences, New Delhi, from May 2021 to June 2021. We obtained their demographic, clinical, and biochemical characteristics at baseline and 48-72 hours prior to the terminal event (survival/death). The data were analyzed to determine the prognostic significance of these markers on the final outcome. Results Higher levels of inflammatory markers were associated with a worse final outcome (ferritin p-value <0.001, c-reactive protein (CRP) p-value <0.001, interleukin 6 (IL-6) p-value 0.007, procalcitonin p-value 0.005, and lactic acid p-value 0.004). Optimal probability cut-offs for these markers for predicting mortality were: ferritin: 963 ng/mL (sensitivity - 67.35%, specificity - 67.50%), CRP: 66.3 mg/L (sensitivity - 78.43%, specificity - 74.12%), IL-6: 46.2 pg/mL (sensitivity - 59.26%, specificity - 59.57%), procalcitonin: 0.3ng/mL (sensitivity - 65.38 %, specificity - 66.67%), lactic acid: 1.5 mg/dL (sensitivity - 59.26%, specificity - 58.57%). Multivariate logistic regression analysis was done, which showed that pre-terminal event CRP was associated with a statistically significant higher risk of mortality (Unadjusted OR 18.89, Adjusted OR 1.008, p=0.002, 95% CI 6.815 - 47.541). Conclusion Inflammatory markers have a prognostic significance in patients with COVID-19, with higher levels being associated with worse outcomes.
引言 细胞因子风暴是2019冠状病毒病（COVID-19）患者发病和死亡的重要原因。本研究的目的是确定促炎细胞因子对COVID-19患者总体最终结局的预后意义。方法 我们对2021年5月至2021年6月在新德里全印度医学科学研究所医学部收治的142例COVID-19患者进行了回顾性研究。我们获取了他们在基线时以及终末事件（生存/死亡）前48 - 72小时的人口统计学、临床和生化特征。对数据进行分析以确定这些标志物对最终结局的预后意义。结果 较高水平的炎症标志物与较差的最终结局相关（铁蛋白p值<0.001，C反应蛋白（CRP）p值<0.001，白细胞介素6（IL-6）p值0.007，降钙素原p值0.005，乳酸p值0.004）。这些标志物预测死亡率的最佳概率截断值为：铁蛋白：963 ng/mL（敏感性 - 67.35%，特异性 - 67.50%），CRP：66.3 mg/L（敏感性 - 78.43%，特异性 - 74.12%），IL-6：46.2 pg/mL（敏感性 - 59.26%，特异性 - 59.57%），降钙素原：0.3ng/mL（敏感性 - 65.38 %，特异性 - 66.67%），乳酸：1.5 mg/dL（敏感性 - 59.26%，特异性 - 58.57%）。进行了多变量逻辑回归分析，结果显示终末事件前的CRP与统计学上显著更高的死亡风险相关（未调整的OR为18.89，调整后的OR为1.008，p = 0.002，95% CI为6.815 - 47.541）。结论 炎症标志物对COVID-19患者具有预后意义，水平越高与结局越差相关。
