Lee Gun-Hyuk, Park Mikyoung, Hur Mina, Kim Hanah, Lee Seungho, Moon Hee-Won, Yun Yeo-Min
Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Republic of Korea.
Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.
Diagnostics (Basel). 2023 Jul 14;13(14):2372. doi: 10.3390/diagnostics13142372.
We explored the utility of novel biomarkers, presepsin and interferon-λ3 (IFN-λ3), for predicting disease severity and clinical outcomes in hospitalized Coronavirus (COVID-19) patients. In a total of 55 patients (non-critical, = 16; critical, = 39), presepsin and IFN-λ3 were compared with sequential organ failure assessment (SOFA) scores and age. Disease severity and clinical outcomes (in-hospital mortality, intensive care unit admission, ventilator use, and kidney replacement therapy) were analyzed using receiver operating characteristic (ROC) curves. In-hospital mortality was also analyzed using the Kaplan-Meier method with hazard ratios (HR). SOFA scores, age, presepsin, and IFN-λ3 predicted disease severity comparably (area under the curve [AUC], 0.67-0.73). SOFA score and IFN-λ3 predicted clinical outcomes comparably (AUC, 0.68-0.88 and 0.66-0.74, respectively). Presepsin predicted in-hospital mortality (AUC = 0.74). The combination of presepsin and IFN-λ3 showed a higher mortality risk than SOFA score or age (HR [95% confidence interval, CI], 6.7 [1.8-24.1]; 3.6 [1.1-12.1]; 2.8 [0.8-9.6], respectively) and mortality rate further increased when presepsin and IFN-λ3 were added to SOFA scores or age (8.5 [6.8-24.6], 4.2 [0.9-20.6], respectively). In the elderly (≥65 years), in-hospital mortality rate was significantly higher when both presepsin and IFN-λ3 levels increased than when either one or no biomarker level increased (88.9% vs. 14.3%, < 0.001). Presepsin and IFN-λ3 predicted disease severity and clinical outcomes in hospitalized COVID-19 patients. Both biomarkers, whether alone or added to the clinical assessment, could be useful for managing COVID-19 patients, especially the elderly.
我们探讨了新型生物标志物可溶性髓系细胞触发受体-1（presepsin）和干扰素-λ3（IFN-λ3）在预测住院的冠状病毒病（COVID-19）患者疾病严重程度和临床结局方面的效用。在总共55例患者中（非重症患者16例；重症患者39例），将presepsin和IFN-λ3与序贯器官衰竭评估（SOFA）评分及年龄进行了比较。使用受试者工作特征（ROC）曲线分析疾病严重程度和临床结局（院内死亡率、重症监护病房入住率、机械通气使用率及肾脏替代治疗）。还采用Kaplan-Meier法及风险比（HR）分析院内死亡率。SOFA评分、年龄、presepsin和IFN-λ3对疾病严重程度的预测能力相当（曲线下面积[AUC]为0.67 - 0.73）。SOFA评分和IFN-λ3对临床结局的预测能力相当（AUC分别为0.68 - 0.88和0.66 - 0.74）。Presepsin可预测院内死亡率（AUC = 0.74）。Presepsin与IFN-λ3联合使用时显示出比SOFA评分或年龄更高的死亡风险（HR[95%置信区间，CI]分别为6.7[1.8 - 24.1]；3.6[1.1 - 12.1]；2.8[0.8 - 9.6]），当将presepsin和IFN-λ3加入SOFA评分或年龄模型时死亡率进一步升高（分别为8.5[6.8 - 24.6]，4.2[0.9 - 20.6]）。在老年患者（≥65岁）中，当presepsin和IFN-λ3水平均升高时，院内死亡率显著高于仅一种生物标志物水平升高或两种生物标志物水平均未升高时（88.9%对14.3%，P < 0.001）。Presepsin和IFN-λ3可预测住院COVID-19患者的疾病严重程度和临床结局。这两种生物标志物，无论是单独使用还是加入临床评估中，都可能有助于管理COVID-19患者，尤其是老年患者。
