The role of C-reactive protein as a prognostic marker in COVID-19.
The role of C-reactive protein as a prognostic marker in COVID-19.
复制标题
DOI：
10.1093/ije/dyab012
复制
发表时间：
2021-05-17
影响因子：
7.7
通讯作者：
COPE Study Collaborators
中科院分区：
文献类型：
--
作者：
Stringer D;Braude P;Myint PK;Evans L;Collins JT;Verduri A;Quinn TJ;Vilches-Moraga A;Stechman MJ;Pearce L;Moug S;McCarthy K;Hewitt J;Carter B;COPE Study Collaborators
c反应蛋白（CRP）是一种在感染或炎症中升高的非特异性急性期反应物。较高的水平表明感染更严重，并被用作COVID-19疾病严重程度的指标。然而，CRP作为预后标志物的证据还有待确定。本研究的目的是检查COVID-19住院患者的CRP反应，并确定CRP在入院时预测住院患者死亡率的效用。在2020年2月27日至6月10日期间收集数据，包括两个队列：COPE（老年人中COVID-19）研究，纳入了11家医院收治的1564名诊断为COVID-19的成年患者（测试队列），以及后来的验证队列，纳入了271名患者。对入院CRP进行了调查，并采用有限混合模型来评估可能的潜在分布。此外，在时间-死亡率Cox回归中分析了CRP的不同预后阈值，以确定截止值。采用Bootstrapping方法比较模型性能[Harrell’s C statistic and Akaike information criterion (AIC)]。CRP的测试和验证队列分布不受年龄的影响，混合模型显示双峰分布。CRP≥40mg /L的阈值截断可以很好地预测死亡率（并且与将CRP作为线性变量处理相似）。CRP的分布特征表明，≥40mg /L的最佳临界值与死亡率相关。这个阈值可以帮助临床医生使用CRP作为早期触发因素，以加强观察、治疗决策和高级护理计划。
C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality. Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell’s C statistic and Akaike information criterion (AIC)]. The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable). The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.
登录
查看更多内容
影响因子：
2.9
作者：
Price A;Barlow-Pay F;Duffy S;Pearce L;Vilches-Moraga A;Moug S;Quinn T;Stechman M;Braude P;Mitchell E;Myint PK;Verduri A;McCarthy K;Carter B;Hewitt J;COPE Study Collaborators
通讯作者：
COPE Study Collaborators
DOI：
10.1016/j.cmi.2020.07.016
发表时间：
2020-12
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Westwood D;MacFadden DR;Soucy JR;Daneman N
通讯作者：
Daneman N
DOI：
10.1186/s12941-020-00362-2
发表时间：
2020-05-15
影响因子：
5.7
作者：
Chen, Wei;Zheng, Kenneth I.;Qiao, Zengpei
通讯作者：
Qiao, Zengpei
影响因子：
8.8
作者：
Liu, Fang;Li, Lin;Zhou, Xiang
通讯作者：
Zhou, Xiang
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin