COVID-19相关社区获得性肺炎患者内源性中毒指标分析

A. V. Кucher, S. V. Khodus, O. Prikhodko
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摘要

的目标。目的探讨内源性中毒综合征血液学指标在COVID-19合并肺炎患者中转期的预后意义。材料和方法。分析146例患者的病史,将其分为两组:根据入院诊断科(ADD)的路由结果转至重症监护病房治疗的患者和转至肺科治疗的患者。患者入院后,根据ADD阶段的病例史,进行临床血检评估,计算中毒血液学指标。根据获得的数据,进行ROC分析以确定中毒血液学指标的预后意义。重症监护病房患者在分选阶段,白细胞浓度和中性粒细胞百分比分别比转诊至肺科的患者高25.9%和16.2%,而淋巴细胞百分比和红细胞定量浓度分别比转诊至肺科的患者低26.6%和8.3%。重症监护患者中毒综合指标高38.6%,中毒白细胞指数高74.3%,中毒中性粒细胞/淋巴细胞比值指数高81.5%。在同一组患者中,中性粒细胞与单核细胞之比指数下降28.7%,淋巴细胞与单核细胞之比指数下降44.9%。中毒综合指标敏感性为73.3%,特异性为51.2%;中毒白细胞指数分别为57.3%和51.2%;中性粒细胞/单核细胞比值指标敏感性为57.3%,特异性为59.1%;中性粒细胞与淋巴细胞比值指数分别为68%和60%。由此可见,在ADD初检阶段对COVID- 19社区获得性肺炎患者进行排查,如中毒积分指标、中性粒细胞/淋巴细胞比值指标等中毒血液学参数具有较高的临床预后价值。我们认为,血液中毒指标可以补充预后量表,并作为确定ADD患者路线的另一个标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of indicators of endogenous intoxication in patients with communityacquired pneumonia associated with COVID-19
Aim. To assess the prognostic significance of hematological parameters of endogenous intoxication syndrome at the stage of routing patients with pneumonia associated with COVID-19.Materials and methods. 146 case histories of patients were analyzed, divided into 2 groups: patients who were referred for treatment to intensive care units based on the results of routing in the admission and diagnostic department (ADD) and patients referred for treatment to pulmonology departments. Upon admission of patients to the hospital, according to the case histories at the stage of ADD, an assessment of the clinical blood test was made, the calculation of hematological indicators of intoxication. Based on the data obtained, a ROC analysis was performed to determine the prognostic significance of hematological indicators of intoxication.Results. In patients who were in intensive care units, at the stage of sorting in the ADD, the concentration of leukocytes and the percentage of neutrophils were higher by 25.9 and 16.2%, respectively, in comparison with patients referred for treatment to the pulmonology departments, however, the percentage of lymphocytes and the quantitative concentration of erythrocytes was lower by 26.6 and 8.3%, respectively. The integral indicator of intoxication in patients in intensive care was higher by 38.6%, the leukocyte index of intoxication by 74.3% and the index of the ratio of neutrophils to lymphocytes by 81.5%. In patients of the same group, the index of the ratio of neutrophils to monocytes was lower by 28.7%, the index of the ratio of lymphocytes to monocytes by 44.9%. The sensitivity of the integral indicator of intoxication was 73.3%, the specificity was 51.2%; in the leukocyte index of intoxication – 57.3 and 51.2%, respectively; the sensitivity of the index of the ratio of neutrophils to monocytes was 57.3%, the specificity was 59.1%; the same figures for the index of the ratio of neutrophils to lymphocytes were 68 and 60%, respectively.Conclusion. It can be concluded that there is a rather high clinical prognostic value in the routing of patients with community-acquired pneumonia caused by COVID- 19 at the stage of initial examination in the ADD, such hematological parameters of intoxication as the integral index of intoxication and the index of the ratio of neutrophils to lymphocytes. We believe that hematological indicators of intoxication can complement prognostic scales and be used as another criterion in determining the routing of patients in ADD.
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