Ingrid Didriksson, Maria Lengquist, Martin Spångfors, Märta Leffler, Theodor Sievert, Gisela Lilja, Attila Frigyesi, Hans Friberg, Alexandru Schiopu
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Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.</p><p><strong>Results: </strong>High plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001].</p><p><strong>Conclusion: </strong>In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. 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引用次数: 0
摘要
背景：钙黏蛋白（S100A8/A9）是一种促炎介质，主要由中性粒细胞释放。之前的研究显示，在未经选择的 COVID-19 患者中，血浆钙蛋白、疾病严重程度和院内死亡率之间存在关联：我们旨在评估重症监护第一周的血浆钙蛋白动态是否与 COVID-19 重症患者的死亡率和功能预后有关：这项前瞻性研究纳入了 2020 年 5 月至 2021 年 5 月期间入住瑞典六家重症监护病房 (ICU) 的 498 名 COVID-19 患者。在入住重症监护病房时和第 7 天采集血样。主要结果是 12 个月的死亡率。次要结果是幸存者在 3 个月和 12 个月时的功能预后，以及在重症监护室住院期间是否需要进行有创机械通气 (IMV) 或持续肾脏替代治疗 (CRRT)。功能预后通过格拉斯哥预后量表扩展版（GOSE，范围1-8，含结果）进行评估：入院时和第 7 天的血浆钙蛋白含量高与 12 个月死亡率的增加密切相关。入院至第 7 天血浆钙蛋白含量升高与 12 个月死亡率升高[OR 2.10 (95% CI 1.18-3.74), p = 0.012]、3 个月功能预后不良[OR 2.53 (95% CI 1.07-6.10), p = 0.036]，以及使用 IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] 和 CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]。包括第 7 天钙蛋白和年龄在内的接收器操作者特征（ROC）模型可以很好地预测 12 个月的死亡率[AUC 0.79 (95% CI 0.74-0.84), p 结论：在 COVID-19 重症患者中，入住重症监护室后钙蛋白水平的升高与 12 个月的死亡率和存活者的不良功能预后有关。监测重症监护室血浆钙蛋白动态可用于评估 COVID-19 重症患者的预后：研究注册：ClinicalTrials.gov Identifier：NCT04974775，2020年4月28日注册。
Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients.
Background: Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.
Objective: We aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.
Methods: This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.
Results: High plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001].
Conclusion: In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19.
Study registration: ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.
期刊介绍：
"Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction.
Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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