CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France.
CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France.
PLoS One. 2024 Sep 19;19(9):e0308014. doi: 10.1371/journal.pone.0308014. eCollection 2024.
CT-scan and inflammatory and coagulation biomarkers could help in prognostication of COVID-19 in patients on ICU admission.
The objectives of this study were to measure the prognostic value of the extent of lung parenchymal lesions on computed tomography (CT) and of several coagulation and inflammatory biomarkers, and to explore the characteristics of the patients depending on the extent of lung parenchymal lesions.
Retrospective monocentric observational study achieved on a dataset collected prospectively.
Medical ICU of the university hospital of Clermont-Ferrand, France.
All consecutive adult patients aged ≥18 years admitted between 20 March, 2020 and 31 August, 2021 for COVID-19 pneumonia.
Characteristics at baseline and during ICU stay, and outcomes at day 60 were recorded. The extent of lung parenchyma lesions observed on the chest CT performed on admission was established by artificial intelligence software.
Several clinical characteristics and laboratory features were collected on admission including plasma interleukin-6, HLA-DR monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day-60 mortality were investigated by uni- and multivariate survival analyses.
270 patients were included. Inflammation biomarkers including the levels of neutrophils, CRP, ferritin and Il10 were the indices the most associated with the severity of the extent of the lung lesions. Patients with more extensive lung parenchymal lesions (≥ 75%) on admission had higher CRP serum levels. The extent of lung parenchymal lesions was associated with a decrease in the PaO2/FiO2 ratio(p<0.01), fewer ventilatory-free days (p = 0.03), and a higher death rate at day 60(p = 0.01). Extent of the lesion of more than 75% was independently associated with day-60 mortality (aHR = 1.72[1.06; 2.78], p = 0.03). The prediction of death at day 60 was improved when considering simultaneously biological and radiological markers obtained on ICU admission (AUC = 0.78).
The extent of lung parenchyma lesions on CT was associated with inflammation, and the combination of coagulation and inflammatory biomarkers and the extent of the lesions predicted the poorest outcomes.
CT 扫描和炎症及凝血生物标志物有助于预测 ICU 收治的 COVID-19 患者的预后。
本研究旨在测量肺部 CT 病变程度和几种凝血及炎症生物标志物的预后价值，并根据肺部 CT 病变程度探讨患者的特征。
回顾性单中心观察性研究，基于前瞻性收集的数据进行。
法国克莱蒙费朗大学附属医院的内科重症监护病房。
2020 年 3 月 20 日至 2021 年 8 月 31 日期间连续因 COVID-19 肺炎入住 ICU 的所有成年患者，年龄≥18 岁。
记录患者入住 ICU 时的基线及住院期间的特征，以及第 60 天的结局。通过人工智能软件确定入院时胸部 CT 观察到的肺部病变范围。
入院时采集了多种临床特征和实验室特征，包括血浆白细胞介素-6、单核细胞 HLA-DR 表达率（mHLA-DR）和肺部病变程度。采用单变量和多变量生存分析探讨与第 60 天死亡率相关的因素。
共纳入 270 例患者。炎症生物标志物，包括中性粒细胞、CRP、铁蛋白和 Il10 水平，与肺部病变严重程度最相关。入院时肺部病变程度更广泛（≥75%）的患者血清 CRP 水平更高。肺部病变程度与 PaO2/FiO2 比值降低（p<0.01）、机械通气天数减少（p = 0.03）和第 60 天死亡率升高（p = 0.01）有关。病变程度超过 75%与第 60 天死亡率独立相关（aHR = 1.72[1.06; 2.78]，p = 0.03）。同时考虑 ICU 入院时获得的生物学和影像学标志物，可改善第 60 天死亡的预测（AUC = 0.78）。
肺部 CT 病变程度与炎症有关，凝血和炎症生物标志物的联合以及病变程度预测了最差的结局。
