Kumar Tribhuwan, Bhushan Divendu, Kumar Sushil, Jha Kamlesh, Verma Punam, Ganguly Abhimanyu, Kumar Yogesh, Zabihullah Md
Department of Physiology, AIIMS, Patna, Bihar, India.
Department of Medicine, AIIMS, Patna, Bihar, India.
J Family Med Prim Care. 2022 Jul;11(7):3971-3979. doi: 10.4103/jfmpc.jfmpc_545_22. Epub 2022 Jul 22.
The COVID-19 pandemic has claimed millions of lives. A tool for early prediction of severity and mortality risk is desirable for better utilization of health care facilities. Several biomarkers like D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP) and some recently explored biomarkers like serum cystatin C and serum calprotectin have been proposed as prognostic markers of COVID-19, but their role as prognostic markers is so far undefined. The present work attempted to investigate the possible role of serum cystatin C and serum calprotectin as prognostic tools to predict severity and outcome ahead of time.
This observational cohort study was carried out on 95 COVID-19 patients admitted to a dedicated COVID care facility from mid-October 2020 to January 2021. Serial estimations of serum cystatin C and serum calprotectin levels were done and assessed for significant difference between severe (NEWS 2 score ≥5) and non-severe (NEWS 2 score <5) groups, survivors and deceased and on the basis of comorbidities at each time points. Survival analysis was done based on the optimal thresholds for severity and mortality, calculated from the receiver operating characteristic (ROC).
The results showed that median cystatin C levels were significantly higher on the first day in the severe group ( < 0.001) and in patients with cardiovascular disease ( < 0.05), chronic lung disease ( = 0.009) and among patients who died ( < 0.05). It remained raised on day 3 in severe ( < 0.05) and deceased ( < 0.05) group. Serum calprotectin levels were significantly higher in patients with chronic lung disease ( = 0.008) and in those who died ( < 0.05).
Serum cystatin C could be used as a tool for early prognosis and therapeutic decision-making for COVID-19 patients. Serum calprotectin seems to be a better marker of critical illness.
新冠疫情已夺走数百万人的生命。为了更好地利用医疗设施，需要一种早期预测病情严重程度和死亡风险的工具。几种生物标志物，如D-二聚体、乳酸脱氢酶（LDH）、C反应蛋白（CRP），以及一些最近探索的生物标志物，如血清胱抑素C和血清钙卫蛋白，已被提议作为新冠的预后标志物，但它们作为预后标志物的作用迄今尚未明确。本研究试图探讨血清胱抑素C和血清钙卫蛋白作为预后工具提前预测病情严重程度和预后的可能作用。
本观察性队列研究于2020年10月中旬至2021年1月对95名入住专门新冠护理机构的新冠患者进行。对血清胱抑素C和血清钙卫蛋白水平进行系列测定，并评估重症组（NEWS 2评分≥5）和非重症组（NEWS 2评分<5）、存活者和死亡者之间以及各时间点合并症情况下是否存在显著差异。根据从受试者工作特征（ROC）曲线计算出的病情严重程度和死亡率的最佳阈值进行生存分析。
结果显示，重症组第1天血清胱抑素C的中位数水平显著更高（<0.001），心血管疾病患者（<0.05）、慢性肺病患者（=0.009）以及死亡患者（<0.05）中也是如此。在重症组（<0.05）和死亡组（<0.0５）第3天该指标仍处于升高状态。慢性肺病患者（=0.008）和死亡患者（<0.05）的血清钙卫蛋白水平显著更高。
血清胱抑素C可作为新冠患者早期预后和治疗决策的工具。血清钙卫蛋白似乎是危重病的更好标志物
