Szabó Miklós, Kardos Zsófia, Oláh Csaba, Tamáska Péter, Hodosi Katalin, Csánky Eszter, Szekanecz Zoltán
Department of Pulmonology, Borsod Academic County Hospital, Miskolc, Hungary.
Department of Rheumatology, Borsod Academic County Hospital, Miskolc, Hungary.
Front Med (Lausanne). 2022 Jul 22;9:920016. doi: 10.3389/fmed.2022.920016. eCollection 2022.
Numerous clinical and laboratory scores that include C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase (LDH), interleukin 6 (IL-6), procalcitonin (PCT), blood urea nitrogen (BUN), creatinine levels and oxygenation (PaO and SaO) have been used for the prognosis of COVID-19. In addition, composite scores have been developed for the assessment of general state and risk in community-acquired pneumonia (CAP) that may be applied for COVID-19 as well. In this study, we assessed severity and potential prognostic risk factors for unfavorable outcome among hospitalized COVID-19 patients. We also applied the A-DROP general scoring system used in CAP to COVID-19.
Altogether 233 patients admitted to our center with COVID-19 were included in the study. Clinical status, several laboratory biomarkers described above, indicators of oxygenation were determined at hospital admission. We also applied the A-DROP composite scoring system that includes Age (≥ 70 years in males and ≥ 75 years in females), Dehydration (BUN ≥ 7.5 mmol/l), Respiratory failure (SaO ≤ 90% or PaO ≤ 60 mmHg), Orientation disturbance (confusion) and low blood Pressure (systolic BP ≤ 90 mmHg) to COVID-19.
At the time of admission, most patients had elevated CRP, LDH, ferritin, D-dimer, and IL-6 levels indicating multisystemic inflammatory syndrome (MIS). Altogether 49 patients (21.2%) required admission to ICU, 46 (19.7%) needed ventilation and 40 patients (17.2%) died. In the binary analysis, admission to ICU, the need for ventilation and death were all significantly associated with the duration of hospitalization, history of hypertension or obesity, confusion/dizziness, as well as higher absolute leukocyte and neutrophil and lower lymphocyte counts, elevated CRP, PCT, LDH, ferritin, IL-6, BUN, and creatinine levels, low PaO and SaO and higher A-DROP score at the time of admission ( < 0.05).
Numerous laboratory biomarkers in addition to obesity, dizziness at the time of admission and the history of hypertension may predict the need for ICU admission and ventilation, as well as mortality in COVID-19. Moreover, A-DROP may be a suitable scoring system for the assessment of general health and disease outcome in COVID-19.
许多临床和实验室指标，包括C反应蛋白（CRP）、D-二聚体、铁蛋白、乳酸脱氢酶（LDH）、白细胞介素6（IL-6）、降钙素原（PCT）、血尿素氮（BUN）、肌酐水平和氧合情况（PaO₂和SaO₂）已被用于评估2019冠状病毒病（COVID-19）的预后。此外，还开发了综合评分系统用于评估社区获得性肺炎（CAP）的总体状况和风险，这些系统也可应用于COVID-19。在本研究中，我们评估了住院COVID-19患者的病情严重程度和不良预后的潜在危险因素。我们还将CAP中使用的A-DROP综合评分系统应用于COVID-19。
本研究共纳入233例因COVID-19入住我院的患者。入院时确定临床状况、上述几种实验室生物标志物以及氧合指标。我们还将包括年龄（男性≥70岁，女性≥75岁）、脱水（BUN≥7.5 mmol/L）、呼吸衰竭（SaO₂≤90%或PaO₂≤60 mmHg）、定向障碍（意识模糊）和低血压（收缩压≤90 mmHg）的A-DROP综合评分系统应用于COVID-19。
入院时，大多数患者的CRP、LDH、铁蛋白、D-二聚体和IL-6水平升高，提示多系统炎症综合征（MIS）。共有49例患者（21.2%）需要入住重症监护病房（ICU），46例（占19.7%）需要机械通气，40例患者（占17.2%）死亡。在二元分析中，入住ICU、需要机械通气和死亡均与住院时间、高血压或肥胖病史、意识模糊/头晕、较高的绝对白细胞和中性粒细胞计数以及较低的淋巴细胞计数、升高的CRP、PCT、LDH、铁蛋白、IL-6、BUN和肌酐水平、低PaO₂和SaO₂以及入院时较高的A-DROP评分显著相关（P<0.05）。
除肥胖、入院时头晕和高血压病史外，许多实验室生物标志物可能预测COVID-19患者入住ICU、需要机械通气以及死亡的情况。此外，A-DROP可能是评估COVID-19患者总体健康状况和疾病转归的合适评分系统。
