Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Division of Pediatric Surgery, Department of Surgery; Division of Trauma, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Chin J Physiol. 2021 Nov-Dec;64(6):306-311. doi: 10.4103/cjp.cjp_77_21.
Coronavirus disease 2019 (COVID-19) had caused a worldwide pandemic with public health emergencies since 2020. For the symptomatic patients, high mortality rate was observed if without timely and optimized management. In this study, we aimed to investigate the predictive and prognostic roles of hematologic and biochemical parameters obtained in the emergency department (ED) for COVID-19 patients. We conducted a retrospective study in a dedicated COVID-19 medical center, recruiting a total of 228 COVID-19 patients with 86 severe and 142 non-severe cases. Both the hematologic and biochemical parameters obtained in the ED upon arrival were analyzed to evaluate the association of the biomarkers with disease severity and prognosis among COVID-19 patients. Among these parameters, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, and D-dimer were significantly higher in the severe group than the non-severe one, whereas the platelet count and lymphocyte-to-monocyte ratio were significantly lower. Receiver operating characteristic curve analysis revealed that the areas under curve of CRP, PCT, LDH, ferritin, D-dimer, and NLR for differentiating the severity of COVID-19 were 0.713, 0.755, 0.763, 0.741, 0.733, and 0.683, respectively, whereas the areas under curve of CRP, PCT, LDH, ferritin, D-dimer, and NLR for differentiating the mortality of COVID-19 were 0.678, 0.744, 0.680, 0.676, 0.755, and 0.572, respectively. Logistic regression analysis revealed that CRP, PCT, LDH, ferritin, D-dimer, and NLR were independent indicators for prediction of severe COVID-19, and LDH and ferritin were independent factors associated with the mortality in COVID-19. In conclusion, higher CRP, PCT, LDH, ferritin, D-dimer, and NLR were associated with severe COVID-19, whereas higher LDH and ferritin were associated with the mortality in COVID-19. These findings could help early risk stratification in the ED and contribute to optimized patient management.
2020 年以来，新型冠状病毒病（COVID-19）引发了全球性大流行的公共卫生紧急事件。对于有症状的患者，如果没有及时和优化的管理，观察到高死亡率。在这项研究中，我们旨在探讨急诊科（ED）获得的血液学和生化参数对 COVID-19 患者的预测和预后作用。我们在专门的 COVID-19 医疗中心进行了一项回顾性研究，共招募了 228 名 COVID-19 患者，其中 86 例为重症，142 例为非重症。分析 ED 就诊时获得的血液学和生化参数，以评估生物标志物与 COVID-19 患者疾病严重程度和预后的相关性。在这些参数中，中性粒细胞与淋巴细胞比值（NLR）、C 反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）、铁蛋白和 D-二聚体在重症组中明显高于非重症组，而血小板计数和淋巴细胞与单核细胞比值明显较低。受试者工作特征曲线分析显示，CRP、PCT、LDH、铁蛋白、D-二聚体和 NLR 区分 COVID-19 严重程度的曲线下面积分别为 0.713、0.755、0.763、0.741、0.733 和 0.683，而 CRP、PCT、LDH、铁蛋白、D-二聚体和 NLR 区分 COVID-19 死亡率的曲线下面积分别为 0.678、0.744、0.680、0.676、0.755 和 0.572。Logistic 回归分析显示，CRP、PCT、LDH、铁蛋白、D-二聚体和 NLR 是预测重症 COVID-19 的独立指标，而 LDH 和铁蛋白是 COVID-19 死亡率的独立相关因素。总之，较高的 CRP、PCT、LDH、铁蛋白、D-二聚体和 NLR 与严重 COVID-19 相关，而较高的 LDH 和铁蛋白与 COVID-19 的死亡率相关。这些发现有助于在 ED 进行早期风险分层，并有助于优化患者管理。
