新冠病毒感染的肾移植受者中，衍生实验室生物标志物对30天死亡率的预测效能
Performance of Derived Laboratory Biomarkers with Regard to 30-Day Mortality in Kidney Transplant Recipients with COVID-19.
作者信息
Domjanović Josipa, Domjanović Škopinić Tea, Radić Josipa, Luketin Mirko, Jeličić Ivo, Matetic Andrija
机构信息
Department of Nephrology, University Hospital of Split, 21000 Split, Croatia.
Department of Cardiology, University Hospital of Split, 21000 Split, Croatia.
出版信息
Life (Basel). 2022 Dec 9;12(12):2068. doi: 10.3390/life12122068.
There are limited data on the performance of laboratory-derived biomarkers in kidney transplant recipients (KTR) with COVID-19. This observational study enrolled 65 KTR with COVID-19 who were treated at the University Hospital of Split up to March 2022. Laboratory-derived biomarkers (neutrophile-to-lymphocyte (NLR) ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, De Ritis ratio, C-reactive protein (CRP)-to-albumin ratio, lactate dehydrogenase (LDH)-to-hemoglobin ratio, CRP-to-lymphocyte ratio, red cell distribution width-to-albumin ratio, platelet-to-albumin ratio, D-Dimer-to-albumin ratio, D-Dimer-to-NLR ratio, LDH-to-albumin ratio, and LDH-to-white blood cell (WBC) ratio) were calculated, and their performance with regard to 30-day mortality was determined. Mortality events occurred in 12 patients (18.5%), which was significantly associated with increased De Ritis (HR 3.83, 95% CI 1.57-9.35, = 0.003), CRP-to-albumin (HR 1.36, 95% CI 1.13-1.64, = 0.001), LDH-to-hemoglobin (HR 1.44, 95% CI 1.07-1.92, = 0.015), CRP-to-lymphocyte (HR 1.03, 95% CI 1.01-1.07, = 0.003), D-dimer-to-albumin (HR 4.94, 95% CI 1.38-7.24, = 0.038), LDH-to-albumin (HR 1.20, 95% CI 1.05-1.36, = 0.008), and LDH-to-WBC (HR 1.03 95% CI 1.01-1.05, = 0.024) ratios. Out of these, the best area-under-the-curve (AUC) values were achieved with De Ritis (AUC 0.691), CRP-to-albumin (AUC 0.764), LDH-to-hemoglobin (AUC 0.877), CRP-to-lymphocyte (AUC 0.739), and LDH-to-albumin (AUC 0.827) ratios, while the best discrimination displayed LDH-to-hemoglobin ratio (Harrell's C 0.808 and Somers' D 0.616). The overall calibration was satisfactory for all models. Derived laboratory biomarkers such as the de Ritis, CRP-to-albumin, LDH-to-hemoglobin, CRP-to-lymphocyte, and LDH-to-albumin ratios show significant association and discrimination with all-cause mortality in KTR with COVID-19, suggesting its potential risk stratification role.
关于实验室检测的生物标志物在感染新型冠状病毒肺炎（COVID-19）的肾移植受者（KTR）中的表现，相关数据有限。这项观察性研究纳入了65例在斯普利特大学医院接受治疗直至2022年3月的感染COVID-19的KTR。计算了实验室检测的生物标志物（中性粒细胞与淋巴细胞（NLR）比值、血小板与淋巴细胞比值、单核细胞与淋巴细胞比值、德瑞蒂斯比值、C反应蛋白（CRP）与白蛋白比值、乳酸脱氢酶（LDH）与血红蛋白比值、CRP与淋巴细胞比值、红细胞分布宽度与白蛋白比值、血小板与白蛋白比值、D-二聚体与白蛋白比值、D-二聚体与NLR比值、LDH与白蛋白比值以及LDH与白细胞（WBC）比值），并确定了它们与30天死亡率的关系。12例患者（18.5%）发生死亡事件，这与德瑞蒂斯比值升高（风险比（HR）3.83，95%置信区间（CI）1.57 - 9.35，P = 0.003）、CRP与白蛋白比值（HR 1.36，95% CI 1.13 - 1.64，P = 0.001）、LDH与血红蛋白比值（HR 1.44，95% CI 1.07 - 1.92，P = 0.015）、CRP与淋巴细胞比值（HR 1.03，95% CI 1.01 - 1.07，P = 0.003）、D-二聚体与白蛋白比值（HR 4.94，95% CI 1.38 - 7.24，P = 0.038）、LDH与白蛋白比值（HR 1.20，95% CI 1.05 - 1.36，P = 0.008）以及LDH与WBC比值（HR 1.03，95% CI 1.01 - 1.05，P = 0.024）显著相关。其中，德瑞蒂斯比值（曲线下面积（AUC）0.691）、CRP与白蛋白比值（AUC 0.764）、LDH与血红蛋白比值（AUC 0.877）、CRP与淋巴细胞比值（AUC 0.739）以及LDH与白蛋白比值（AUC 0.827）获得了最佳AUC值，而LDH与血红蛋白比值显示出最佳辨别能力（哈雷尔C指数0.808和萨默斯D指数0.616）。所有模型的总体校准情况令人满意。诸如德瑞蒂斯比值、CRP与白蛋白比值、LDH与血红蛋白比值、CRP与淋巴细胞比值以及LDH与白蛋白比值等实验室衍生的生物标志物，在感染COVID-19的KTR中显示出与全因死亡率存在显著关联和辨别能力，表明其具有潜在的风险分层作用。
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