Takeshita Yuichiro, Terada Jiro, Hirasawa Yasutaka, Kinoshita Taku, Tajima Hiroshi, Koshikawa Ken, Kinouchi Toru, Isaka Yuri, Shionoya Yu, Fujikawa Atsushi, Kato Yasuyuki, To Yasuo, Tada Yuji, Tsushima Kenji
Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan.
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Front Med (Lausanne). 2022 Aug 9;9:935255. doi: 10.3389/fmed.2022.935255. eCollection 2022.
This study aims to create and validate a useful score system predicting the hyper-inflammatory conditions of COVID-19, by comparing it with the modified H-score.
A total of 98 patients with pneumonia (without oxygen therapy) who received initial administration of casirivimab/imdevimab or remdesivir were included in the study. The enrolled patients were divided into two groups: patients who required corticosteroid due to deterioration of pneumonia, assessed by chest X-ray or CT or respiratory failure, and those who did not, and clinical parameters were compared.
Significant differences were detected in respiratory rate, breaths/min, SpO, body temperature, AST, LDH, ferritin, and IFN-λ3 between the two groups. Based on the data, we created a corticosteroid requirement score: (1) the duration of symptom onset to treatment initiation ≥ 7 d, (2) the respiratory rate ≥ 22 breaths/min, (3) the SpO ≤ 95%, (4) BT ≥ 38.5°C, (5) AST levels ≥ 40 U/L, (6) LDH levels ≥ 340 U/L, (7) ferritin levels ≥ 800 ng/mL, and (8) IFN-λ3 levels ≥ 20 pg/mL. These were set as parameters of the steroid predicting score. Results showed that the area under the curve (AUC) of the steroid predicting score (AUC: 0.792, 95%CI: 0.698-0.886) was significantly higher than that of the modified H-score (AUC: 0.633, 95%CI: 0.502-0.764).
The steroid predicting score may be useful to predict the requirement of corticosteroid therapy in patients with COVID-19. The data may provide important information to facilitate a prospective study on a larger scale in this field.
本研究旨在通过与改良H评分进行比较，创建并验证一个预测COVID-19炎症状态的实用评分系统。
本研究纳入了98例初始接受卡西瑞韦单抗/伊德维单抗或瑞德西韦治疗的肺炎患者（未接受氧疗）。将入选患者分为两组：因肺炎恶化（通过胸部X线或CT评估）、呼吸衰竭而需要使用糖皮质激素的患者，以及不需要使用糖皮质激素的患者，并比较临床参数。
两组在呼吸频率（次/分钟）、SpO、体温、AST、LDH、铁蛋白和IFN-λ3方面存在显著差异。基于这些数据，我们创建了一个糖皮质激素需求评分：（1）症状出现至开始治疗的持续时间≥7天，（2）呼吸频率≥22次/分钟，（3）SpO≤95%，（4）体温≥38.5°C，（5）AST水平≥40 U/L，（6）LDH水平≥340 U/L，（7）铁蛋白水平≥800 ng/mL，（8）IFN-λ3水平≥20 pg/mL。这些被设定为糖皮质激素预测评分的参数。结果显示，糖皮质激素预测评分的曲线下面积（AUC：0.792，95%CI：0.698 - 0.886）显著高于改良H评分（AUC：0.633，95%CI：0.502 - 0.764）。
糖皮质激素预测评分可能有助于预测COVID-19患者对糖皮质激素治疗的需求。这些数据可能为该领域大规模前瞻性研究提供重要信息。
