COVID-19 短期恶化的生物标志物:前瞻性多中心 COVIDeF 队列中的多参数分析。

IF 3.1 4区 医学 Q1 EMERGENCY MEDICINE
Marta Cancella de Abreu,Jacques Ropers,Nathalie Oueidat,Laurence Pieroni,Corinne Frère,Michaela Fontenay,Krystel Torelino,Anthony Chauvin,Guillaume Hekimian,Anne-Geneviève Marcelin,Beatrice Parfait,Florence Tubach,Pierre Hausfater,
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引用次数: 0

摘要

背景在像 COVID-19 这样的大流行期间,医院资源有限,需要对患者进行准确的严重程度分流。目的本研究的目的是评估 COVID-19 短期恶化 (STW) 候选生物标志物的预测性能。设计在 2020 年法国 COVID-19 第一波(COVIDeF 队列)期间,对连续 COVID-19 患者进行入院时系统性生物库收集的前瞻性、多中心(巴黎 20 家医院)队列研究。如果存在严重程度标准,即采样前入住 ICU、机械通气(包括无创通气)、急性呼吸窘迫或院内死亡,则排除这些患者。在常规护理期间进行常规血液检测,并对肌酸激酶、C反应蛋白(CRP)、降钙素原、可溶性尿激酶纤溶酶原激活物受体(suPAR)、高敏肌钙蛋白T(TnT-hs)、N末端前B钠尿肽(NT-proBNP)、calprotectin、血小板因子4、中区域前肾上腺髓质素(MR-proADM)和前内皮素进行集中系统检测。结果测量和分析:主要结果是 STW,以 7 天内的严重程度标准定义。采用后向逐步逻辑回归模型和 "最佳子集 "方法确定独立关联,并计算接受操作者特征下面积(AUROC)。出现严重程度标准的中位时间为 3 天。入院时,嗜酸性粒细胞、淋巴细胞、血小板、丙氨酸氨基转移酶的数值较低,而中性粒细胞、肌酐、尿素、CRP、TnT-hs、suPAR、NT-proBNP、钙蛋白、降钙素原、MR-proADM 和前皮质素的数值较高,这些都是预测病情恶化的指标。逐步逻辑回归确定了三种与病情恶化显著相关的生物标志物:CRP [调整后的几率比(aOR):1.10,95% 置信区间(95% CI):1.06-1.15(增加 10 个单位),AUROC:0.73(0.66-0.79)]、降钙素原[aOR:0.42,95% CI:0.22-0.81,AUROC:0.69(0.64-0.88)]和 MR-proADM [aOR:2.85,95% CI:1.74-4.69,AUROC:0.75(0.69-0.81)]。结论在这项多中心前瞻性研究中,CRP、降钙素原和MR-proADM与STW风险独立相关,该研究评估了COVID-19患者的大量生物标志物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort.
BACKGROUND During a pandemic like COVID-19, hospital resources are constrained and accurate severity triage of the patients is required. OBJECTIVE The objective of this study is to estimate the predictive performances of candidate biomarkers for short-term worsening (STW) of COVID-19. DESIGN Prospective, multicenter (20 hospitals in Paris) cohort study of consecutive COVID-19 patients with systematic biobanking at admission, during the first waves of COVID-19 in France in 2020 (COVIDeF cohort). SETTING AND PARTICIPANTS Consecutive COVID-19 patients were screened for inclusion. They were excluded in presence of severity criteria defined by either an ICU admission, mechanical ventilation (including noninvasive ventilation), acute respiratory distress, or in-hospital death before sampling. Routine blood tests measured during usual care and centralized systematic measurement of creatine kinase, C-reactive protein (CRP), procalcitonin, soluble urokinase plasminogen activator receptor (suPAR), high-sensitive troponin T (TnT-hs), N terminal pro-B natriuretic peptide (NT-proBNP), calprotectin, platelet factor 4, mid-regional pro-adrenomedullin (MR-proADM), and proendothelin were performed. OUTCOME MEASURES AND ANALYSES The primary outcome was STW, defined by a severity criteria within 7 days. A backward stepwise logistic regression model and a 'best subset' approach were used to identify independent association, and the area under the receiving operator characteristics (AUROC) was computed. RESULTS Five hundred and eleven patients were analyzed, of whom 60 (11.7%) experienced STW. Median time to occurrence of a severity criteria was 3 days. At admission, lower values of eosinophils, lymphocytes, platelets, alanine aminotransferase, and higher values of neutrophils, creatinine, urea, CRP, TnT-hs, suPAR, NT-proBNP, calprotectin, procalcitonin, MR-proADM, and proendothelin were predictive of worsening. Stepwise logistic regression identified three biomarkers significantly associated with worsening: CRP [adjusted odds ratio (aOR): 1.10, 95% confidence interval (95% CI): 1.06-1.15 for a 10-unit increase, AUROC: 0.73 (0.66-0.79)], procalcitonin [aOR: 0.42, 95% CI: 0.22-0.81, AUROC: 0.69 (0.64-0.88)], and MR-proADM [aOR: 2.85, 95% CI: 1.74-4.69, AUROC: 0.75 (0.69-0.81)]. These biomarkers outperformed clinical variables except diabetes and cancer comorbidities. CONCLUSION In this multicenter prospective study that assessed a large panel of biomarkers for COVID-19 patients, CRP, procalcitonin, and MR-proADM were independently associated with the risk of STW. TRIAL REGISTRATION ClinicalTrials.gov NCT04352348.
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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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