Witarto Andro Pramana, Rosyid Alfian Nur, Witarto Bendix Samarta, Pramudito Shidi Laras, Putra Achmad Januar Er
Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya.
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya.
Monaldi Arch Chest Dis. 2024 Jul 26. doi: 10.4081/monaldi.2024.2848.
Krebs von den Lungen-6 (KL-6) is a glycoprotein mainly expressed by type II pneumocytes and recently known as a lung injury biomarker. However, the number of studies is still limited, especially in Indonesian COVID-19 populations. Therefore, we aim to provide correlation, sensitivity, and specificity analyses of KL-6 and other biomarkers in Indonesian COVID-19 severity and mortality. We conducted a cross-sectional study involving adult COVID-19 patients at Universitas Airlangga Hospital, Surabaya, East Java, Indonesia, between March 26, 2021, and August 25, 2021. KL-6 and other biomarker levels were compared according to severity (severe versus non-severe) and mortality (non-survivor versus survivor). We also included the receiver operating characteristic analysis to define the optimal cut-off, sensitivity, and specificity of KL-6 to determine COVID-19 severity and mortality. We enrolled 78 COVID- 19 patients (23 non-survivors), including 39 non-severe and 39 severe patients. There was no significant difference in serum KL-6 levels, neither in severity nor mortality groups. KL-6 had the strongest positive correlations with ferritin in severe patients (r=0.313) and non-survivors (r=0.467). We observed that the best sensitivity was KL-6 combined with platelet-to- lymphocyte ratio (PLR) (0.818) in severe patients and with neutrophil-to-lymphocyte ratio (NLR)/PLR/ferritin/C-reactive protein (0.867) in non-survivors. In contrast, the best specificity was found when KL-6 was combined with NLR/D-dimer (0.750) in severe patients and with D-dimer (0.889) in non-survivors. Serum KL-6 is a useful auxiliary laboratory evaluation index for COVID-19 lung injury to depict its severity and mortality.
肺表面活性物质相关蛋白A（KL-6）是一种主要由II型肺细胞表达的糖蛋白，最近被认为是一种肺损伤生物标志物。然而，相关研究数量仍然有限，尤其是在印度尼西亚的新冠病毒病（COVID-19）患者群体中。因此，我们旨在对印度尼西亚COVID-19患者的病情严重程度和死亡率与KL-6及其他生物标志物进行相关性、敏感性和特异性分析。我们于2021年3月26日至2021年8月25日在印度尼西亚东爪哇省泗水市的艾尔朗加大学医院开展了一项涉及成年COVID-19患者的横断面研究。根据病情严重程度（重症与非重症）和死亡率（非幸存者与幸存者）比较KL-6及其他生物标志物水平。我们还进行了受试者工作特征分析，以确定KL-6用于判断COVID-19病情严重程度和死亡率的最佳临界值、敏感性和特异性。我们纳入了78例COVID-19患者（23例非幸存者），包括39例非重症患者和39例重症患者。血清KL-6水平在病情严重程度组和死亡率组中均无显著差异。在重症患者中，KL-6与铁蛋白的正相关性最强（r=0.313），在非幸存者中，KL-6与铁蛋白的正相关性最强（r=0.467）。我们观察到，在重症患者中KL-6与血小板与淋巴细胞比值（PLR）联合使用时敏感性最佳（0.818），在非幸存者中KL-6与中性粒细胞与淋巴细胞比值（NLR）/PLR/铁蛋白/C反应蛋白联合使用时敏感性最佳（0.867）。相比之下，在重症患者中KL-6与NLR/D-二聚体联合使用时特异性最佳（0.750），在非幸存者中KL-6与D-二聚体联合使用时特异性最佳（0.889）。血清KL-6是评估COVID-19肺损伤严重程度和死亡率的有用辅助实验室指标。
