炎性指标在新型冠状病毒感染患者中的表达及其短期预后评估价值

doi:10.19871/j.cnki.xfcrbzz.2023.03.012

摘要/Abstract

摘要： 目的探讨炎性指标对新型冠状病毒感染疾病分型和短期住院期间（30d内）不良结局的预测价值。方法回顾性分析2022年12月1日至2022年12月31日成都市公共卫生临床医疗中心收治住院的新型冠状病毒感染患者共168例,根据患者预后生存情况,将好转出院的142例患者作为预后良好组,转入ICU或死亡的26例作为预后不良组,比较两组患者的白细胞计数（WBC）、淋巴细胞计数（LYM）、白介素6（IL-6）、C反应蛋白（CRP）、降钙素原（PCT）;采用多因素Logistic回归分析影响新型冠状病毒感染患者住院预后因素,并绘制受试者工作特征曲线（ROC曲线）。结果 ①与预后良好组比较,预后不良组WBC[（7.60±4.66）×10⁹/L比（4.99±2.41）×10⁹/L]、 IL-6[38.20（17.03,68.50）pg/ml比8.60（4.78,16.03）pg/ml]、CRP[34.21（12.43,93.19）mg/L比2.98（2.98,16.45）mg/L]、PCT[0.40（0.10,1.70）ng/ml比0.06（0.04,0.10）ng/ml]均高于预后良好组（P<0.05）;LYM[（0.77±0.38）×10⁹/L比（1.13±0.54）×10⁹/L]低于预后良好组（P<0.05）。②多因素Logistic回归模型分析结果显示,CRP升高是新型冠状病毒感染发展为预后不良相关的独立危险因素,而未合并基础疾病及轻症（轻型/普通型）患者为新型冠状病毒感染的独立保护因素。③ROC曲线分析显示,相比于其他危险因素,高CRP、合并基础疾病、重症（重型/危重型）患者对新型冠状病毒感染患者发展至预后不良的风险评估具有较好的预测价值。当CRP高于13.765mg/L时,判断预后不良的敏感度76.90%,特异度73.90%,曲线下面积（AUC）为0.757（95%CI：0.638~0.876,P<0.001）;合并基础疾病时的AUC为0.654（95%CI：0.552,0.756,P=0.013）;重症患者的AUC为0.716（95%CI：0.605~0.827,P<0.001）。当三者联合诊断时,敏感度84.60%,特异度70.40%,AUC为0.850（95%CI：0.772~0.929,P<0.001）。结论炎性指标升高特别是高水平CRP、合并基础疾病及重症患者,可作为新型冠状病毒感染患者病情恶化的早期预警指标,三者联合诊断效能更高。

关键词: 新型冠状病毒, 炎性指标, 短期预后, 诊断效能

Abstract: Objective The predictive value of inflammatory indexes on disease staging and adverse outcomes during short-term hospitalization（within 30 days） for COVID-19. Method A total of 168 patients admitted to the Chengdu Public Health Clinical Medical Center from December 1, 2022 to December 31, 2022 were retrospectively analyzed, and 142 patients who improved and were discharged as the good prognosis group and 26 patients who were transferred to the ICU or died as the poor prognosis group according to the patients, prognosis survival, and the two groups were compared for white blood cell count (WBC), lymphocyte count (LYM), interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT); logistic regression model was used to analyze the factors affecting the prognosis of hospitalization in patients with novel coronavirus infection, and the subject operating characteristic curve (ROC) was drawn. Result ①WBC [(7.60±4.66)×10⁹/L vs (4.99±2.41)×10⁹/L)], IL-6 [38.20(17.03, 68.50)pg/ml vs 8.60(4.78,16.03)pg/ml], CRP[34.21(12.43,93.19)mg/L vs 2.98(2.98,16.45)mg/L], PCT[0.40(0.10,1.70)ng/ml vs 0.06(0.04,0.10)ng/ml] were higher than those in the good prognosis group (P<0.05), and LYM [(0.77±0.38)×10⁹/L vs (1.13±0.54)×10⁹/L)] were lower than those in the good prognosis group (P<0.05)．The results of multi-factorial logistic regression model analysis showed that elevated CRP was an independent risk factor for the development of novel coronavirus infection associated with poor prognosis, while the uncomplicated underlying disease and mild disease groups were independent protective factors for novel coronavirus infection. The ROC curve analysis showed that high CRP, combined underlying disease, and the severe disease group had a better predictive value for risk assessment of patients with novel coronavirus infection developing to poor prognosis compared with other risk factors. When CRP was higher than 13.765mg/L, the sensitivity for determining poor prognosis was 76.90%, the specificity was 73.90%, and the area under the curve (AUC) was 0.757 (95% CI 0.638-0.876, P<0.001); AUC for combined underlying disease was 0.654 (95% CI: 0.552-0.756, P=0.013); and AUC in the severe disease group was 0.716 (95% CI: 0.605-0.827, P<0.001). When the three were combined for diagnosis, the sensitivity was 84.60%, the specificity 70.40%, and AUC was 0.850 (95% CI: 0.772-0.929, P<0.001). Conclusion Elevated inflammatory indicators, especially high levels of CRP, combined underlying disease and severe disease groups can be used as early warning indicators of deterioration during hospitalization in patients with the novel coronavirus infection, and the combined diagnostic efficacy of the three is higher.

Key words: Severe acute respiratory syndrome coronavirus 2, Inflammatory index, Short-term prognosis, Diagnostic efficacy

中图分类号:

R512.99

李桃, 谢利秋, 何江林, 冯宪标, 马瑶, 罗春强, 杨发清, 黎慧灵, 张娜, 侯可可. 炎性指标在新型冠状病毒感染患者中的表达及其短期预后评估价值[J]. 新发传染病电子杂志, 2023, 8(3): 59-63.

Li Tao, Xie Liqiu, He Jianglin, Feng Xianbiao, Ma Yao, Luo Chunqiang, Yang Faqing, Li Huilin, Zhang Na, Hou Keke. Expression of inflammatory markers in hospitalized patients with COVID-19 and its short-term prognostic value[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(3): 59-63.

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