Harvard Medical School, Division of Postgraduate Medical Education, Boston, MA, USA.
School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico.
Infect Dis (Lond). 2022 Nov;54(11):810-818. doi: 10.1080/23744235.2022.2101691. Epub 2022 Jul 19.
COVID-19 may trigger an acute hyperinflammatory syndrome characterised by heightened levels of acute phase reactants and is associated with adverse outcomes among hospitalised individuals. The relationship between 48-hour changes in acute phase reactants and adverse outcomes is unclear. This study evaluated the relationship between change in four acute phase reactants (interleukin-6, procalcitonin, ferritin, and C-reactive protein), and the risk for in-hospital death and invasive mechanical ventilation.
A retrospective cohort among 2,523 adult patients hospitalised with COVID-19 pneumonia was conducted. Changes in IL-6, procalcitonin, ferritin, and CRP from admission to 48 h after admission were recorded. Delta was calculated using the difference in each acute phase reactant at admission and at 48-hours. Delta in acute phase reactants and the risk for in-hospital death and invasive mechanical ventilation was assessed using logistic regression models adjusting for demographics and comorbidities.
Patients with both admission and 48-hour measurement for interleukin-6 (IL-6) ( = 541), procalcitonin ( = 828), ferritin ( = 1022), and C-reactive protein (CRP) ( = 1919) were included. Baseline characteristics were similar across all four populations. Increases in ferritin associated with a heightened risk of in-hospital death (OR 1.00032; 95%CI 1.00007- 1.00056; < .001) and invasive mechanical ventilation (OR 1.00035; 95%CI 1.00014- 1.00055; = .001). Therefore, for every 100 ng/mL increase in ferritin, the odds for in-hospital death and invasive mechanical ventilation increase by 3.2% and 3.5%, respectively.
Delta in ferritin is associated with in-hospital death and invasive mechanical ventilation. Other acute phase reactants were not associated with these outcomes among COVID-19 inpatients.
COVID-19 可能引发以急性期反应物水平升高为特征的急性高炎症综合征，并与住院患者的不良结局相关。急性期反应物在 48 小时内的变化与不良结局之间的关系尚不清楚。本研究评估了四种急性期反应物（白细胞介素-6、降钙素原、铁蛋白和 C 反应蛋白）变化与住院死亡和有创机械通气风险之间的关系。
对 2523 例成人 COVID-19 肺炎住院患者进行回顾性队列研究。记录入院至入院后 48 小时白细胞介素-6、降钙素原、铁蛋白和 C 反应蛋白的变化。使用入院时和 48 小时时每个急性期反应物的差异计算 Δ。使用调整了人口统计学和合并症的 logistic 回归模型评估急性期反应物的 Δ 与住院死亡和有创机械通气的风险。
纳入了白细胞介素-6（IL-6）（ = 541）、降钙素原（ = 828）、铁蛋白（ = 1022）和 C 反应蛋白（CRP）（ = 1919）均有入院和 48 小时测量值的患者。所有四个群体的基线特征相似。铁蛋白的增加与住院死亡（OR 1.00032；95%CI 1.00007-1.00056； < .001）和有创机械通气（OR 1.00035；95%CI 1.00014-1.00055； = .001）的风险增加相关。因此，铁蛋白每增加 100ng/mL，住院死亡和有创机械通气的几率分别增加 3.2%和 3.5%。
铁蛋白的 Δ 与住院死亡和有创机械通气相关。COVID-19 住院患者的其他急性期反应物与这些结局无关。
