新冠病毒疾病患者细胞群体数据的预后价值

Prognostic value of cellular population data in patients with COVID-19.

作者信息

Vasse Marc, Sukhachev Dmitry, Ballester Marie-Christine, Delcominette Frédérique, Mellot François, Habarou Florence, Védrenne Aurélie, Jolly Emilie, Sukhacheva Elena, Farfour Eric, Pascreau Tiffany

机构信息

Service de Biologie Clinique, Hôpital Foch, Suresnes, France.

UMRS 1176, Hôpital du Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.

出版信息

Inform Med Unlocked. 2023;38:101207. doi: 10.1016/j.imu.2023.101207. Epub 2023 Mar 8.

DOI:10.1016/j.imu.2023.101207

PMID:36919041

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9991930/

Abstract

BACKGROUND AND AIMS

Beckman Coulter hematology analysers identify leukocytes by their volume (V), conductivity (C) and scatter (S) of a laser beam at different angles. Each leukocyte sub-population [neutrophils (NE), lymphocytes (LY), monocytes (MO)] is characterized by the mean (MN) and the standard deviation (SD) of 7 measurements called "cellular population data" (@CPD), corresponding to morphological analysis of the leukocytes. As severe forms of infections to SARS-CoV-2 are characterized by a functional activation of mononuclear cells, leading to a cytokine storm, we evaluated whether CPD variations are correlated to the inflammation state, oxygen requirement and lung damage and whether CPD analysis could be useful for a triage of patients with COVID-19 in the Emergency Department (ED) and could help to identify patients with a high risk of worsening.

MATERIALS AND METHOD

The CPD of 825 consecutive patients with proven COVID-19 presenting to the ED were recorded and compared to classical biochemical parameters, the need for hospitalization in the ward or ICU, the need for oxygen, or lung injury on CT-scan.

RESULTS

40 of the 42 CPD were significantly modified in COVID-19 patients in comparison to 245 controls. @MN-V-MO and @SD-V-MO were highly correlated with C-reactive protein, procalcitonin, ferritin and D-dimers. SD-UMALS-LY > 21.45 and > 23.92 identified, respectively, patients with critical lung injuries (>75%) and requiring tracheal intubation. @SD-V-MO > 25.03 and @SD-V-NE > 19.4 identified patients required immediate ICU admission, whereas a @MN-V-MO < 183 suggested that the patient could be immediately discharged. Using logistic regression, the combination of 8 CPD with platelet and basophil counts and the existence of diabetes or obesity could identify patients requiring ICU after a first stay in conventional wards (area under the curve = 0.843).

CONCLUSION

CPD analysis constitutes an easy and inexpensive tool for triage and prognosis of COVID-19 patients in the ED.

摘要

背景与目的

贝克曼库尔特血液分析仪通过白细胞的体积（V）、电导率（C）以及激光束在不同角度的散射（S）来识别白细胞。每个白细胞亚群[中性粒细胞（NE）、淋巴细胞（LY）、单核细胞（MO）]都由7项测量值的平均值（MN）和标准差（SD）来表征，这7项测量值被称为“细胞群体数据”（@CPD），与白细胞的形态学分析相对应。由于严重的新型冠状病毒2型（SARS-CoV-2）感染以单核细胞的功能激活为特征，进而导致细胞因子风暴，我们评估了CPD变化是否与炎症状态、氧需求和肺损伤相关，以及CPD分析对于急诊科（ED）中2019冠状病毒病（COVID-19）患者的分诊是否有用，是否有助于识别病情恶化风险高的患者。

材料与方法

记录了825例连续到急诊科就诊且确诊为COVID-19患者的CPD，并与经典生化参数、在病房或重症监护病房（ICU）住院的需求、氧需求或CT扫描显示的肺损伤情况进行比较。

结果

与245名对照相比，42项CPD中的40项在COVID-19患者中发生了显著改变。@MN-V-MO和@SD-V-MO与C反应蛋白、降钙素原、铁蛋白和D-二聚体高度相关。SD-UMALS-LY > 21.45和> 23.92分别识别出有严重肺损伤（>75%）和需要气管插管的患者。@SD-V-MO > 25.03和@SD-V-NE > 19.4识别出需要立即入住ICU的患者，而@MN-V-MO < 183表明患者可以立即出院。使用逻辑回归分析，8项CPD与血小板和嗜碱性粒细胞计数以及糖尿病或肥胖的存在相结合，可以识别出在首次入住普通病房后需要入住ICU的患者（曲线下面积 = 0.843）。