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寻找评估新冠肺炎患者的新生物标志物:一项初步研究。

Searching for New Biomarkers to Assess COVID-19 Patients: A Pilot Study.

作者信息

Goncharov Nikolay V, Avdonin Piotr P, Voitenko Natalia G, Voronina Polina A, Popova Polina I, Novozhilov Artemy V, Blinova Maria S, Popkova Victoria S, Belinskaia Daria A, Avdonin Pavel V

机构信息

Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, Saint Petersburg 194223, Russia.

Koltsov Institute of Developmental Biology, Russian Academy of Sciences, Moscow 119334, Russia.

出版信息

Metabolites. 2023 Dec 10;13(12):1194. doi: 10.3390/metabo13121194.

Abstract

During the initial diagnosis of urgent medical conditions, which include acute infectious diseases, it is important to assess the severity of the patient's clinical state as quickly as possible. Unlike individual biochemical or physiological indicators, derived indices make it possible to better characterize a complex syndrome as a set of symptoms, and therefore quickly take a set of adequate measures. Recently, we reported on novel diagnostic indices containing butyrylcholinesterase (BChE) activity, which is decreased in COVID-19 patients. Also, in these patients, the secretion of von Willebrand factor (vWF) increases, which leads to thrombosis in the microvascular bed. The objective of this study was the determination of the concentration and activity of vWF in patients with COVID-19, and the search for new diagnostic indices. One of the main objectives was to compare the prognostic values of some individual and newly derived indices. Patients with COVID-19 were retrospectively divided into two groups: survivors (n = 77) and deceased (n = 24). According to clinical symptoms and computed tomography (CT) results, the course of disease was predominantly moderate in severity. The first blood sample (first point) was taken upon admission to the hospital, the second sample (second point)-within 4-6 days after admission. Along with the standard spectrum of biochemical indicators, BChE activity (BChEa or BChEb for acetylthiocholin or butyrylthiocholin, respectively), malondialdehyde (MDA), and vWF analysis (its antigen level, AGFW, and its activity, ActWF) were determined and new diagnostic indices were derived. The pooled sensitivity, specificity, and area under the receiver operating curve (AUC), as well as Likelihood ratio (LR) and Odds ratio (OR) were calculated. The level of vWF antigen in the deceased group was 1.5-fold higher than the level in the group of survivors. Indices that include vWF antigen levels are superior to indices using vWF activity. It was found that the index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) had the best discriminatory power to predict COVID-19 mortality (AUC = 0.91 [0.83, 1.00], < 0.0001; OR = 72.0 [7.5, 689], = 0.0002). In addition, [Urea] × 1000/(BChEb × [ALB]) was a good predictor of mortality (AUC = 0.95 [0.89, 1.00], < 0.0001; OR = 31.5 [3.4, 293], = 0.0024). The index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) was the best predictor of mortality associated with COVID-19 infection, followed by [Urea] × 1000/(BChEb × [ALB]). After validation in a subsequent cohort, these two indices could be recommended for diagnostic laboratories.

摘要

在对包括急性传染病在内的紧急医疗状况进行初步诊断时,尽快评估患者临床状态的严重程度非常重要。与单个生化或生理指标不同,衍生指标能够更好地将复杂综合征表征为一组症状,从而能够迅速采取一系列适当措施。最近,我们报道了包含丁酰胆碱酯酶(BChE)活性的新型诊断指标,该指标在新冠肺炎患者中降低。此外,在这些患者中,血管性血友病因子(vWF)的分泌增加,这会导致微血管床血栓形成。本研究的目的是测定新冠肺炎患者中vWF的浓度和活性,并寻找新的诊断指标。主要目标之一是比较一些单个指标和新衍生指标的预后价值。新冠肺炎患者被回顾性分为两组:幸存者(n = 77)和死亡者(n = 24)。根据临床症状和计算机断层扫描(CT)结果,疾病进程主要为中度严重。第一份血样(第一个时间点)在入院时采集,第二份血样(第二个时间点)在入院后4 - 6天内采集。除了标准的生化指标谱外,还测定了BChE活性(分别针对乙酰硫代胆碱或丁酰硫代胆碱的BChEa或BChEb)、丙二醛(MDA)以及vWF分析(其抗原水平AGFW及其活性ActWF),并得出了新的诊断指标。计算了合并敏感性、特异性、受试者操作特征曲线下面积(AUC)以及似然比(LR)和比值比(OR)。死亡组中vWF抗原水平比幸存者组高1.5倍。包含vWF抗原水平的指标优于使用vWF活性的指标。发现指标[尿素]×[AGWF]×1000 /(BChEb×[白蛋白])对预测新冠肺炎死亡率具有最佳鉴别能力(AUC = 0.91 [0.83, 1.00],P < 0.0001;OR = 72.0 [7.5, 689],P = 0.0002)。此外,[尿素]×1000 /(BChEb×[白蛋白])是死亡率的良好预测指标(AUC = 0.95 [0.89, 1.00],P < 0.0001;OR = 31.5 [3.4, 293],P = 0.0024)。指标[尿素]×[AGWF]×1000 /(BChEb×[白蛋白])是与新冠肺炎感染相关死亡率的最佳预测指标,其次是[尿素]×1000 /(BChEb×[白蛋白])。在后续队列中验证后,这两个指标可推荐给诊断实验室。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6061/10745512/cc2c95e9d5a0/metabolites-13-01194-g001.jpg

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