Georgakopoulou Vasiliki E, Vlachogiannis Nikolaos I, Basoulis Dimitrios, Eliadi Irene, Georgiopoulos Georgios, Karamanakos Georgios, Makrodimitri Sotiria, Samara Stamatia, Triantafyllou Maria, Voutsinas Pantazis M, Ntziora Fotinie, Psichogiou Mina, Samarkos Michael, Sfikakis Petros P, Sipsas Nikolaos V
Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
J Clin Med. 2022 Mar 25;11(7):1810. doi: 10.3390/jcm11071810.
We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020−20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (n = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820−0.926). This score performed well in an unselected patient cohort (n = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683−0.753), as well as in a mixed cohort (n = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656−0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.
我们旨在寻找2020年9月16日至2021年12月20日期间在一所学术中心连续收治的成年新冠肺炎重症患者的实验室预测指标。患者均接受低分子量肝素治疗，当血氧饱和度（SpO2）<94%时加用地塞米松和瑞德西韦。在连续纳入的无基础疾病的未接种疫苗患者中（n = 241，中位年龄49岁，71%为男性），22例（9.1%）发展为重症疾病，2例死亡（0.8%）。入院时的白细胞计数、中性粒细胞、中性粒细胞与淋巴细胞比值、C反应蛋白（CRP）、纤维蛋白原、铁蛋白、乳酸脱氢酶（LDH）和γ-谷氨酰转移酶（γ-GT）分别与重症疾病单因素相关。经ROC曲线确定的临界值显示，CRP>61.8 mg/L、纤维蛋白原>616.5 mg/dL和LDH>380.5 U/L均与重症疾病发生相关，且独立于年龄、性别和症状出现天数。一个综合了高于临界值的CRP（0/2）、LDH（0/1）和纤维蛋白原（0/1）的评分可预测重症疾病（曲线下面积[AUC]：0.873，95%置信区间[CI]：0.820−0.926）。该评分在主要感染α变异株的未筛选患者队列（n = 1228，100%未接种疫苗）中表现良好（AUC：0.718，95% CI：0.683−0.753），在主要感染δ变异株的混合队列（n = 527，65%未接种疫苗）中也表现良好（AUC：0.708，95% CI：0.656−0.760）。因此，我们提出，急性炎症反应、细胞死亡和高凝状态的标准生物标志物组合可独立于合并症、年龄和性别反映新冠肺炎本身的严重程度，对未筛选患者的风险分层具有价值。
