Department of Gerontology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Eur Rev Med Pharmacol Sci. 2023 May;27(10):4782-4791. doi: 10.26355/eurrev_202305_32489.
The aim of this study was to determine the association of inflammation and immune responses with the outcomes of patients at various stages, and to develop risk stratification for improving clinical practice and reducing mortality.
We included 77 patients with primary outcomes of either death or survival. Demographics, clinical features, comorbidities, and laboratory tests were compared. Linear, logistic, and Cox regression analyses were performed to determine prognostic factors.
The average age was 59 years (35-87 years). There were 12 moderate cases (16.2%), 42 severe cases (54.5%), and 23 critical cases (29.9%); and 41 were male (53.2%). Until March 20, 68 cases were discharged (88.3%), and nine critically ill males (11.7%) died. Interleukin-6 (IL-6) levels on the 1st day were compared with IL-6 values on the 14th day in the severe and the critically ill surviving patients (F=4.90, p=0.034, β=0.35, 95% CI: 0.00-0.10), and predicted death in the critically ill patients (p=0.028, β=0.05, OR: 1.05, 95% CI: 1.01-1.10). CD4+ T-cell counts at admission decreased the hazard ratio of death (p=0.039, β=-0.01, hazard ratio=0.99, 95% CI: 0.98-1.00, and median survival time 13.5 days).
The present study demonstrated that IL-6 levels and CD4+ T-cell count at admission played key roles of predictors in the prognosis, especially for critically ill patients. High levels of IL-6 and impaired CD4+t cells are seen in severe and critically ill patients with COVID-19.
本研究旨在确定炎症和免疫反应与各阶段患者结局的关系，并制定风险分层以改善临床实践和降低死亡率。
我们纳入了 77 例主要结局为死亡或存活的患者。比较了人口统计学、临床特征、合并症和实验室检查。进行线性、逻辑和 Cox 回归分析以确定预后因素。
平均年龄为 59 岁（35-87 岁）。有 12 例中度病例（16.2%）、42 例重度病例（54.5%）和 23 例危重症病例（29.9%）；41 例为男性（53.2%）。截至 2023 年 3 月 20 日，68 例出院（88.3%），9 例危重症男性（11.7%）死亡。在重度和危重症存活患者中，第 1 天的白细胞介素 6（IL-6）水平与第 14 天的 IL-6 值进行比较（F=4.90，p=0.034，β=0.35，95%CI：0.00-0.10），并预测了危重症患者的死亡（p=0.028，β=0.05，OR：1.05，95%CI：1.01-1.10）。入院时 CD4+T 细胞计数降低了死亡的风险比（p=0.039，β=-0.01，风险比=0.99，95%CI：0.98-1.00，中位生存时间为 13.5 天）。
本研究表明，入院时的 IL-6 水平和 CD4+T 细胞计数在预后预测中起着关键作用，特别是对危重症患者。COVID-19 重度和危重症患者的 IL-6 水平较高，CD4+T 细胞受损。
