Belkhir Donia, Blibech Hana, Kaabi Line, Miladi Saoussen, Jebali Mohamed Aymen, Daghfous Jalloul, Mehiri Nadia, Laatar Ahmed, Ben Salah Nozha, Snene Houda, Louzir Bechir
Pulmonology, University Hospital Center Mongi Slim, La Marsa, Tunis, Tunisia.
Rheumatology, University Hospital Center Mongi Slim, La Marsa, Tunis, Tunisia.
F1000Res. 2024 Nov 18;13:918. doi: 10.12688/f1000research.151333.2. eCollection 2024.
BACKGROUND: COVID-19 disease has spread rapidly worldwide, causing high mortality. Accessible biomarkers capable of early identification of patients at risk of severe form are needed in clinical practice. The aim of the study was to determine the biological markers that predict a critical condition. METHODS: Retrospective study including patients with confirmed COVID-19 hospitalized between September 2020 and June 2021. The primary endpoint was progression to critical status within 7 days from admission. We defined two groups:Critical group: Patients who developed a critical condition or died or transferred to the ICU before or at 7 day.Non-critical group: Patients who remained in non-critical respiratory status until 7 day or discharged before or at 7 day. RESULTS: Our study included 456 patients, with a sex ratio of 1.32 and an average age of 62 years. At the 7 day of hospitalization, 115 (25.2%) patients were in the critical group and 341 (74.8%) patients were in the non-critical group. The univariate logistic regression indicated that laboratory findings between non-critical and critical groups showed that C-reactive protein (CRP) (p=0.047), D-Dimer (p=0.011), creatinine (0.026), creatine kinase (p=0.039), lactate dehydrogenase (p=0.04), and troponin (p=0.001) were all higher among patients in critical group. However, lymphocyte (p<0.001) and platelet (p<0.001) counts were significantly lower among the critical group. Multivariate logistic regression model, identified four independent risk factors: lymphopenia (OR=2.771, 95%CI=1.482-5.181, p=0.001), Neutrophil to Lymphocyte Ratio (NLR) (OR=2.286, 95%CI=1.461-3.578, p<0.001), thrombocytopenia (OR=1.944, 95%CI=1.092-3.459, p=0.024), and CRP>71.5 (OR=1.598, 95% CI=1.042-2.45, p=0.032) were associated to critical group. CONCLUSIONS: Our results show the predictive value of lymphopenia, thrombocytopenia, high NLR and CRP levels to evaluate the prognosis of COVID-19 pneumonia. A prognostic score could be proposed for guiding clinical care and improving patient outcomes.
背景：新型冠状病毒肺炎（COVID-19）已在全球迅速传播，导致高死亡率。临床实践中需要能够早期识别有重症风险患者的可获取生物标志物。本研究的目的是确定预测危重症状态的生物标志物。 方法：回顾性研究纳入2020年9月至2021年6月期间确诊COVID-19并住院的患者。主要终点是入院后7天内进展为危重症状态。我们定义了两组：危重症组：在7天之前或之时出现危重症状态、死亡或转入重症监护病房（ICU）的患者。非危重症组：直到7天仍处于非危重症呼吸状态或在7天之前或之时出院的患者。 结果：我们的研究纳入了456例患者，男女比例为1.32，平均年龄为62岁。在住院第7天，115例（25.2%）患者属于危重症组，341例（74.8%）患者属于非危重症组。单因素逻辑回归表明，非危重症组和危重症组之间的实验室检查结果显示，危重症组患者的C反应蛋白（CRP）（p = 0.047）、D-二聚体（p = 0.011）、肌酐（0.026）、肌酸激酶（p = 0.039）、乳酸脱氢酶（p = 0.04）和肌钙蛋白（p = 0.001）均较高。然而，危重症组患者的淋巴细胞（p<0.001）和血小板（p<0.001）计数显著较低。多因素逻辑回归模型确定了四个独立危险因素：淋巴细胞减少（比值比[OR]=2.771，95%置信区间[CI]=1.482 - 5.181，p = 0.001）、中性粒细胞与淋巴细胞比值（NLR）（OR = 2.286，95%CI = 1.461 - 3.578，p<0.001）、血小板减少（OR = 1.944，95%CI = 1.092 - 3.459，p = 0.024）以及CRP>71.5（OR = 1.598，95%CI = 1.042 - 2.45，p = 0.032）与危重症组相关。 结论：我们的结果显示了淋巴细胞减少、血小板减少、高NLR和CRP水平对评估COVID-19肺炎预后的预测价值。可以提出一个预后评分来指导临床护理并改善患者结局。
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