COVID-19患者严重程度的预后指标:一项meta分析

Q3 Medicine

中国全科医学 Pub Date : 2021-01-01 DOI:10.12114/j.issn.1007-9572.2021.00.548

J. Wang, J. Li, Y. Tian, Y. Li

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The modified Jaded Scale was used to assess the methodological quality. Stata 12.0 was used for meta-analysis. Results Fifteen RCTs were included, involving 1 476 cases, all were assessed with high methodological quality(modified Jadad Scale score ranging from 4 to 5 points). Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28, 95%CI (-3.60, -0.98), P<0.001〕, CRP〔SMD=-2.23, 95%CI (-3.38, -1.07), P<0.001〕, IL-6〔SMD=-2.97, 95%CI (-4.94, -1.00), P<0.001〕, and D-dimer〔SMD=-1.22, 95%CI (-2.66, 0.21), P=0.008〕than non-severe COVID-19 patients. Severe COVID-19 patients had lower mean LYM〔SMD=1.41, 95%CI (0.34, 2.48), P<0.001〕. The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11, 95%CI (-9.98, 1.76), P=0.007〕, CRP〔SMD=-2.73, 95%CI (-4.21, -1.25), P<0.001〕, IL-6〔SMD=-3.79, 95%CI (-4.90, -2.67), P<0.001〕, and D-dimer〔SMD=-0.68, 95%CI (-1.46, 0.09), P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08, 95%CI (0.93, 3.22), P<0.001〕. Conclusion Increased PCT, CRP, IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients, indicating that the former three may be positively correlated with severity, while the latter may be negatively correlated with severity. These five indicators may be used as prognostic indicators for severity, too high PCT, CRP, IL-6 and D-dimer, and too low LYM may suggest a poor prognosis. 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Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28, 95%CI (-3.60, -0.98), P<0.001〕, CRP〔SMD=-2.23, 95%CI (-3.38, -1.07), P<0.001〕, IL-6〔SMD=-2.97, 95%CI (-4.94, -1.00), P<0.001〕, and D-dimer〔SMD=-1.22, 95%CI (-2.66, 0.21), P=0.008〕than non-severe COVID-19 patients. Severe COVID-19 patients had lower mean LYM〔SMD=1.41, 95%CI (0.34, 2.48), P<0.001〕. The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11, 95%CI (-9.98, 1.76), P=0.007〕, CRP〔SMD=-2.73, 95%CI (-4.21, -1.25), P<0.001〕, IL-6〔SMD=-3.79, 95%CI (-4.90, -2.67), P<0.001〕, and D-dimer〔SMD=-0.68, 95%CI (-1.46, 0.09), P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08, 95%CI (0.93, 3.22), P<0.001〕. 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引用次数: 0

摘要

新冠肺炎已成为世界卫生组织宣布的全球大流行，其严重程度影响着患者的预后。目的探讨COVID-19患者病情严重程度的预后指标及其预测价值，为临床预测患者预后及预后提供参考。方法检索Cochrane Library、Embase、PubMed、Web of Science、中国医学信息网、中国知网、万方数据知识服务平台、VIP等8个数据库，检索从成立之日至2020-09-03期间，以降钙素原(PCT)、c反应蛋白(CRP)、淋巴细胞计数(LYM)、白细胞介素-6 (IL-6)、d -二聚体为预后指标的重症与非重症、死亡与存活的COVID-19患者的随机对照试验(RCTs)。采用改良的Jaded量表评估方法学质量。meta分析采用Stata 12.0。结果纳入15项随机对照试验(rct)，共1 476例，方法学质量均较高(修正Jadad量表评分4 ~ 5分)。meta分析发现，重症患者的PCT均值[SMD=-2.28, 95%CI (-3.60， -0.98)， P<0.001]、CRP [SMD=-2.23, 95%CI (-3.38， -1.07)， P<0.001]、IL-6 [SMD=-2.97, 95%CI (-4.94， -1.00)， P<0.001]、d -二聚体[SMD=-1.22, 95%CI (-2.66, 0.21)， P=0.008]均高于非重症患者。重症患者的平均LYM较低[SMD=1.41, 95%CI (0.34, 2.48)， P<0.001]。死亡的COVID-19患者的PCT平均值[SMD=-4.11, 95%CI (-9.98, 1.76)， P=0.007]、CRP [SMD=-2.73, 95%CI (-4.21， -1.25)， P<0.001]、IL-6 [SMD=-3.79, 95%CI (-4.90， -2.67)， P<0.001]、d -二聚体[SMD=-0.68, 95%CI (-1.46, 0.09)， P=0.009]均高于存活患者。死亡的COVID-19患者平均LYM较低[SMD=2.08, 95%CI (0.93, 3.22)， P<0.001]。结论COVID-19重症或死亡患者PCT、CRP、IL-6、d -二聚体升高，LYM下降，前三者可能与严重程度呈正相关，后者可能与严重程度负相关。这五项指标可作为严重程度的预后指标，PCT、CRP、IL-6、d -二聚体过高，LYM过低提示预后较差。版权所有©2021中国全科医生。

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Prognostic Indicators for Severity in COVID-19 Patients:a Meta-analysis

Background The COVID-19 has become a global pandemic declared by the WHO, and the severity of which affects the prognosis of patients. Objective To explore the prognostic indicators for severity and their predictive values in COVID-19 patients, providing a reference for clinical prediction of patients'outcome and prognosis. Methods Eight databases (The Cochrane Library, Embase, PubMed, Web of Science, SinoMed, CNKI, Wanfang Data Knowledge Service Platform, VIP)were searched from inception to 2020-09-03 for randomized controlled trials(RCTs)about severe versus non-severe COVID-19 patients or deceased versus survived COVID-19 patients with prognostic indicators〔including procalcitonin (PCT), C-reactive protein (CRP), lymphocyte count (LYM), interleukin-6 (IL-6), D-dimer〕studied. The modified Jaded Scale was used to assess the methodological quality. Stata 12.0 was used for meta-analysis. Results Fifteen RCTs were included, involving 1 476 cases, all were assessed with high methodological quality(modified Jadad Scale score ranging from 4 to 5 points). Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28, 95%CI (-3.60, -0.98), P<0.001〕, CRP〔SMD=-2.23, 95%CI (-3.38, -1.07), P<0.001〕, IL-6〔SMD=-2.97, 95%CI (-4.94, -1.00), P<0.001〕, and D-dimer〔SMD=-1.22, 95%CI (-2.66, 0.21), P=0.008〕than non-severe COVID-19 patients. Severe COVID-19 patients had lower mean LYM〔SMD=1.41, 95%CI (0.34, 2.48), P<0.001〕. The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11, 95%CI (-9.98, 1.76), P=0.007〕, CRP〔SMD=-2.73, 95%CI (-4.21, -1.25), P<0.001〕, IL-6〔SMD=-3.79, 95%CI (-4.90, -2.67), P<0.001〕, and D-dimer〔SMD=-0.68, 95%CI (-1.46, 0.09), P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08, 95%CI (0.93, 3.22), P<0.001〕. Conclusion Increased PCT, CRP, IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients, indicating that the former three may be positively correlated with severity, while the latter may be negatively correlated with severity. These five indicators may be used as prognostic indicators for severity, too high PCT, CRP, IL-6 and D-dimer, and too low LYM may suggest a poor prognosis. Copyright © 2021 by the Chinese General Practice.

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来源期刊

中国全科医学 Medicine-Family Practice

CiteScore

0.70

自引率

0.00%

发文量

27733

期刊介绍： Chinese General Practice, established in 1998 and approved by the National Press and Publication Administration, is governed by the National Health Commission and sponsored by the Chinese Hospital Association and the Publishing House of Journal of Chinese General Practice. The journal aims to promote the concept of "wellness," provide timely reporting of outcomes in general practice and clinical research, and facilitate the development of general practice and community health services in China. It also aims to disseminate general practice research globally and establish a platform for scientific research and academic exchange. The target audience of the journal includes researchers, educational personnel, policy makers, managing staff, and professionals in general practice and community health services, as well as those in related specialties.