COVID-19的预后预测因素：墨西哥人群中急性全身炎症指标分析
Outcome predictors in COVID-19: An analysis of emergent systemic inflammation indices in Mexican population.
作者信息
Gutiérrez-Pérez Ilse Adriana, Buendía-Roldán Ivette, Pérez-Rubio Gloria, Chávez-Galán Leslie, Hernández-Zenteno Rafael de Jesus, Aguilar-Duran Hiram, Fricke-Galindo Ingrid, Zaragoza-García Oscar, Falfán-Valencia Ramcés, Guzmán-Guzmán Iris Paola
机构信息
HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo, Mexico.
出版信息
Front Med (Lausanne). 2022 Oct 21;9:1000147. doi: 10.3389/fmed.2022.1000147. eCollection 2022.
INTRODUCTION
The systemic viral disease caused by the SARS-CoV-2 called coronavirus disease 2019 (COVID-19) continues to be a public health problem worldwide.
OBJECTIVE
This study is aimed to evaluate the association and predictive value of indices of systemic inflammation with severity and non-survival of COVID-19 in Mexican patients.
MATERIALS AND METHODS
A retrospective study was carried out on 807 subjects with a confirmed diagnosis of COVID-19. Clinical characteristics, acute respiratory distress syndrome (ARDS), severity according to PaO/FiO ratio, invasive mechanical ventilation (IMV), and non-survival outcome were considered to assess the predictive value and the association of 11 systemic inflammatory indices derived from hematological parameters analyzed at the hospital admission of patients. The receiver operating characteristics curve was applied to determine the thresholds for 11 biomarkers, and their prognostic values were assessed the Kaplan-Meier method.
RESULTS
26% of the studied subjects showed COVID-19 severe (PaO/FiO ratio ≤ 100), 82.4% required IMV, and 39.2% were non-survival. The indices NHL, NLR, RDW, dNLR, and SIRI displayed predictive values for severe COVID-19 and non-survival. NHL, SIRI, and NLR showed predictive value for IMV. The cut-off values for RDW (OR = 1.85, < 0.001), NHL (OR = 1.67, = 0.004) and NLR (OR = 1.56, = 0.012) were mainly associated with severe COVID-19. NHL (OR = 3.07, < 0.001), AISI (OR = 2.64, < 0.001) and SIRI (OR = 2.51, < 0.001) were associated with IMV support, while for non-survival the main indices associated were NHL (OR = 2.65, < 0.001), NLR (OR = 2.26, < 0.001), dNLR (OR = 1.92, < 0.001), SIRI (OR = 1.67, = 0.002) and SII (OR = 1.50, = 0.010). The patients with an RDW, PLR, NLR, dNLR, MLR, SII, and NHL above the cut-off had a survival probability of COVID-19 50% lower, with an estimated mean survival time of 40 days.
CONCLUSION
The emergent systemic inflammation indices NHL, NLR, RDW, SII, and SIRI have a predictive power of severe COVID-19, IMV support, and low survival probability during hospitalization by COVID-19 in Mexican patients.
引言
由严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）引起的系统性病毒疾病，即2019冠状病毒病（COVID-19），仍然是全球范围内的一个公共卫生问题。
目的
本研究旨在评估全身炎症指标与墨西哥COVID-19患者病情严重程度及死亡情况之间的关联和预测价值。
材料与方法
对807例确诊为COVID-19的患者进行回顾性研究。考虑临床特征、急性呼吸窘迫综合征（ARDS）、根据动脉血氧分压/吸入氧浓度（PaO/FiO）比值判断的严重程度、有创机械通气（IMV）以及死亡结局，以评估患者入院时分析的11项基于血液学参数得出的全身炎症指标的预测价值及相关性。应用受试者工作特征曲线确定11种生物标志物的阈值，并采用Kaplan-Meier法评估其预后价值。
结果
26%的研究对象表现为COVID-19重症（PaO/FiO比值≤100），82.4%需要IMV，39.2%死亡。中性粒细胞与淋巴细胞比值（NHL）、中性粒细胞与淋巴细胞比率（NLR）、红细胞分布宽度（RDW）、动态NLR（dNLR）和全身炎症反应指数（SIRI）对重症COVID-19和死亡具有预测价值。NHL、SIRI和NLR对IMV具有预测价值。RDW（比值比[OR]=1.85，P<0.001）、NHL（OR=1.67，P=0.004）和NLR（OR=1.56，P=0.012）的临界值主要与重症COVID-19相关。NHL（OR=3.07，P<0.001）、年龄与炎症和全身免疫指数（AISI）（OR=2.64，P<0.001）和SIRI（OR=2.51，P<0.001）与IMV支持相关，而与死亡相关的主要指标是NHL（OR=2.65，P<0.001）、NLR（OR=2.26，P<0.001）、dNLR（OR=1.92，P<0.001）、SIRI（OR=1.67，P=0.002）和全身感染炎症指标（SII）（OR=1.50，P=0.010）。RDW、血小板与淋巴细胞比率（PLR）、NLR、dNLR、单核细胞与淋巴细胞比率（MLR）、SII和NHL高于临界值的患者，COVID-19的生存概率降低50%，估计平均生存时间为40天。
结论
新出现的全身炎症指标NHL、NLR、RDW、SII和SIRI对墨西哥COVID-19患者住院期间的重症COVID-19、IMV支持及低生存概率具有预测能力。
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