Feigin Eugene, Levinson Tal, Wasserman Asaf, Shenhar-Tsarfaty Shani, Berliner Shlomo, Ziv-Baran Tomer
Departments of Internal Medicine D and E, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel.
Infectious Diseases Unit, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel.
J Clin Med. 2022 May 10;11(10):2682. doi: 10.3390/jcm11102682.
Background: Several biomarkers and models have been proposed to predict in-hospital mortality among COVID-19 patients. However, these studies have not examined the association in sub-populations. The present study aimed to identify the association between the two most common inflammatory biomarkers in the emergency department and in-hospital mortality in subgroups of patients. Methods: A historical cohort study of adult patients who were admitted to acute-care hospital between March and December 2020 and had a diagnosis of COVID-19 infection. Data on age, sex, Charlson comorbidity index, white blood cell (WBC) count, C-reactive protein (CRP), and in-hospital mortality were collected. Discrimination ability of each biomarker was observed and the CHAID method was used to identify the association in subgroups of patients. Results: Overall, 762 patients (median age 70.9 years, 59.7% males) were included in the study. Of them, 25.1% died during hospitalization. In-hospital mortality was associated with higher CRP (median 138 mg/L vs. 85 mg/L, p < 0.001), higher WBC count (median 8.5 vs. 6.6 K/µL, p < 0.001), and higher neutrophil-to-lymphocyte ratio (NLR) (median 9.2 vs. 5.4, p < 0.001). The area under the ROC curve was similar among all biomarkers (WBC 0.643, NLR 0.677, CRP 0.646, p > 0.1 for all comparisons). The CHAID method revealed that WBC count was associated with in-hospital mortality in patients aged 43.1−66.0 years (<11 K/µL: 10.1% vs. 11+ K/µL: 27.9%), NLR in patients aged 66.1−80 years (≤8: 15.7%, >8: 43.3%), and CRP in patients aged 80.1+ years (≤47 mg/L: 18.8%, 47.1−149 mg/L: 43.1%, and 149.1+: 71.7% mortality). Conclusions: WBC, NLR, and CRP present similar discrimination abilities. However, each biomarker should be considered as a predictor for in-hospital mortality in different age groups.
已经提出了几种生物标志物和模型来预测COVID-19患者的院内死亡率。然而，这些研究尚未考察亚组中的关联。本研究旨在确定急诊科中两种最常见的炎症生物标志物与患者亚组院内死亡率之间的关联。方法：对2020年3月至12月期间入住急症医院且诊断为COVID-19感染的成年患者进行一项历史性队列研究。收集了年龄、性别、查尔森合并症指数、白细胞（WBC）计数、C反应蛋白（CRP）和院内死亡率的数据。观察了每种生物标志物的辨别能力，并使用CHAID方法确定患者亚组中的关联。结果：总体而言，762名患者（中位年龄70.9岁，男性占59.7%）纳入研究。其中，25.1%在住院期间死亡。院内死亡率与较高的CRP（中位数138mg/L对85mg/L，p<0.001）、较高的WBC计数（中位数8.5对6.6K/µL，p<0.001）以及较高的中性粒细胞与淋巴细胞比率（NLR）（中位数9.2对5.4，p<0.001）相关。所有生物标志物的ROC曲线下面积相似（WBC为0.643，NLR为0.677，CRP为0.646，所有比较的p>0.1）。CHAID方法显示，WBC计数与43.1 - 66.0岁患者的院内死亡率相关（<11K/µL：10.1%对11 + K/µL：27.9%），NLR与66.1 - 80岁患者的院内死亡率相关（≤8：15.7%，>8：43.3%），CRP与80.1岁及以上患者的院内死亡率相关（≤47mg/L：18.8%，47.1 - 149mg/L：43.1%，以及149.1 +：71.7%死亡率）。结论：WBC、NLR和CRP具有相似的辨别能力。然而，每种生物标志物都应被视为不同年龄组院内死亡率的预测指标。
