Prognostic value of serum albumin and urea nitrogen excretion in COVID-19 ICU patients: a single-center, prospective, cohort study

I. Leyderman, N. Lesteva, I. Kasherininov, A. Kuzmin, P. Akhimov, S. Barinova, N. Z. Kanshaov, V. Mazurok
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引用次数: 1

Abstract

Introduction. Catabolic syndrome is typical for most critical illness situations. A long progressive course of hypercatabolism is considered by a number of authors as a prognostic criterion for negative clinical outcome of the disease. Objective. Evaluation of the prognostic value of some indicators of the severity of catabolic syndrome in ICU patients with COVID-19. Materials and methods. A prospective cohort study was conducted in 55 patients of the intensive care unit in the period from May 2020 to March 2021. The severity of hypercatabolism was determined by the dynamics of serum albumin and daily urinary nitrogen excretion within 14 days from admission to the ICU. Comparative analysis of nonparametric quantitative data was carried out using the Mann–Whitney test. To determine the predictive value of the diagnostic test, we plotted using the curves of operating characteristics (ROC, Receiver Operating Characteristics) with the subsequent determination of the sensitivity and specificity at the separation point. Results. ROC analysis revealed moderate sensitivity (75.9 %) and low specificity (58.1 %) of the daily urinary nitrogen excretion during the first 14 days of treatment in the ICU in patients with severe SARS-CoV-2. It was also shown that the dynamics of serum albumin has a low predictive value for negative clinical outcome. It should be noted that in the group of survived patients a significant increase in daily urinary nitrogen excretion was observed on days 4–7 (p = 0.022) and 8–14 (p = 0.01) of intensive therapy. Conclusion. Nitrogen urinary excretion is a more accurate prognostic marker of poor clinical outcome than serum albumin in ICU patients with severe COVID-19. The main feature of the catabolic syndrome in patients with positive clinical outcome is a progressive increase in the rate of urinary nitrogen excretion from 4 to 14 days after admission to ICU. © 2021, Practical Medicine Publishing House LLC. All rights reserved.
COVID-19 ICU患者血清白蛋白和尿素氮排泄的预后价值:一项单中心、前瞻性队列研究
介绍。分解代谢综合征是大多数危重疾病的典型症状。长期的进行性高分解代谢过程被许多作者认为是该疾病阴性临床结果的预后标准。目标。评价COVID-19重症监护病房患者分解代谢综合征严重程度部分指标的预后价值材料和方法。前瞻性队列研究于2020年5月至2021年3月对55例重症监护室患者进行。高分解代谢的严重程度通过入院后14天内血清白蛋白和每日尿氮排泄的动态来确定。采用Mann-Whitney检验对非参数定量数据进行对比分析。为了确定诊断试验的预测价值,我们使用工作特征曲线(ROC, Receiver operating characteristics)进行绘图,并随后确定分离点的敏感性和特异性。结果。ROC分析显示重症SARS-CoV-2患者在ICU治疗前14天每日尿氮排泄量的敏感性中等(75.9%),特异性较低(58.1%)。研究还表明,血清白蛋白的动态变化对阴性临床结果的预测价值较低。值得注意的是,生存组患者在强化治疗的第4-7天(p = 0.022)和第8-14天(p = 0.01)每日尿氮排泄量显著增加。结论。尿氮排泄量比血清白蛋白更能准确预测重症COVID-19 ICU患者临床预后不良。临床转归阳性患者分解代谢综合征的主要特点是入ICU后4 ~ 14天尿氮排泄率进行性增高。©2021,实用医学出版社有限责任公司保留所有权利。
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