Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Front Immunol. 2023 Mar 21;14:1130821. doi: 10.3389/fimmu.2023.1130821. eCollection 2023.
There remains a need to better identify patients at highest risk for developing severe Coronavirus Disease 2019 (COVID-19) as additional waves of the pandemic continue to impact hospital systems. We sought to characterize the association of receptor for advanced glycation end products (RAGE), SARS-CoV-2 nucleocapsid viral antigen, and a panel of thromboinflammatory biomarkers with development of severe disease in patients presenting to the emergency department with symptomatic COVID-19.
Blood samples were collected on arrival from 77 patients with symptomatic COVID-19, and plasma levels of thromboinflammatory biomarkers were measured.
Differences in biomarkers between those who did and did not develop severe disease or death 7 days after presentation were analyzed. After adjustment for multiple comparisons, RAGE, SARS-CoV-2 nucleocapsid viral antigen, interleukin (IL)-6, IL-10 and tumor necrosis factor receptor (TNFR)-1 were significantly elevated in the group who developed severe disease (all <0.05). In a multivariable regression model, RAGE and SARS-CoV-2 nucleocapsid viral antigen remained significant risk factors for development of severe disease (both <0.05), and each had sensitivity and specificity >80% on cut-point analysis.
Elevated RAGE and SARS-CoV-2 nucleocapsid viral antigen on emergency department presentation are strongly associated with development of severe disease at 7 days. These findings are of clinical relevance for patient prognostication and triage as hospital systems continue to be overwhelmed. Further studies are warranted to determine the feasibility and utility of point-of care measurements of these biomarkers in the emergency department setting to improve patient prognostication and triage.
随着大流行的持续影响医院系统,需要更好地识别出患有严重 2019 年冠状病毒病(COVID-19)的高危患者。我们试图描述晚期糖基化终产物受体(RAGE)、SARS-CoV-2 核衣壳病毒抗原和一组血栓炎症生物标志物与因 COVID-19 出现症状而到急诊科就诊的患者发展为严重疾病的关联。
从 77 名出现症状的 COVID-19 患者到达时采集血液样本,并测量血浆中血栓炎症生物标志物的水平。
分析了在出现症状后 7 天发展为严重疾病或死亡的患者与未发展为严重疾病或死亡的患者之间的生物标志物差异。经过多次比较调整后,在发生严重疾病的组中,RAGE、SARS-CoV-2 核衣壳病毒抗原、白细胞介素(IL)-6、IL-10 和肿瘤坏死因子受体(TNFR)-1 显着升高(均<0.05)。在多变量回归模型中,RAGE 和 SARS-CoV-2 核衣壳病毒抗原仍然是发展为严重疾病的重要危险因素(均<0.05),并且在切点分析中每个都具有>80%的灵敏度和特异性。
急诊科就诊时 RAGE 和 SARS-CoV-2 核衣壳病毒抗原升高与 7 天内严重疾病的发生密切相关。这些发现对患者预后和分诊具有临床意义,因为医院系统继续不堪重负。需要进一步研究以确定在急诊科环境中测量这些生物标志物的即时检测的可行性和实用性,以改善患者的预后和分诊。