Relationship Among Clinically Obtained Biomarkers of Inflammation, Hypercoagulability, and Macrophage Activation, and Delirium in Critically Ill Patients With COVID-19.
Relationship Among Clinically Obtained Biomarkers of Inflammation, Hypercoagulability, and Macrophage Activation, and Delirium in Critically Ill Patients With COVID-19.
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DOI：
10.1097/cce.0000000000000851
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发表时间：
2023-01
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患有COVID-19的重症患者谵妄和昏迷的发生率很高。谵妄是否通过COVID-19中的新机制发生尚不清楚。我们分析了炎症生物标志物（C-反应蛋白[CRP]）、高凝状态（d-二聚体）和肺巨噬细胞活化（铁蛋白）之间的关系，以及第二天谵妄/昏迷的主要复合结局。我们还测量了生物标志物与第二天谵妄和昏迷之间的相关性，以及谵妄的严重程度。回顾性、观察性队列研究。两个大型城市学术转诊医院的ICU。2020年3月1日至2020年6月7日期间入住ICU的所有连续成年患者，均患有COVID-19，并进行了临床生物标志物和谵妄评估。没有。每日CRP，d-二聚体和铁蛋白的浓度。每日两次测量昏迷（通过里士满躁动-镇静量表评估）和谵妄（通过ICU的意识模糊评估方法/ICU-7的意识模糊评估方法评估）。纳入了197名患有COVID-19的ICU患者的队列。较高的d-二聚体（比值比[OR]，1.57; 95%CI，1.17-2.12; p < 0.01）和铁蛋白四分位数（OR，1.36; 95%CI，1.02-1.81; p < 0.01）与第二天谵妄/昏迷复合结局的比值较大相关。d-二聚体与第二天谵妄（OR，1.49; 95%CI，1.14-1.94; p < 0.01）和昏迷独立（OR，1.52; 95%CI，1.08-2.14; p = 0.017）的几率更大相关。较高的铁蛋白四分位数与第二天谵妄（OR，1.33; 95%CI，1.04-1.70; p = 0.026）和昏迷（OR，1.59; 95%CI，1.14-2.23; p < 0.01）的独立几率较高相关。较高的CRP四分位数与次日昏迷（OR，1.36; 95% CI，1.03-1.79; p = 0.030）和谵妄严重程度（β = 0.30; se，0.07; p ≤ 0.01）相关。我们的假设产生的研究发现，d-二聚体和铁蛋白与第二天的谵妄/昏迷，以及谵妄和昏迷独立。CRP与次日昏迷和谵妄严重程度相关。需要更大规模的研究来验证这些结果。
Critically ill patients with COVID-19 experience high rates of delirium and coma. Whether delirium occurs through novel mechanisms in COVID-19 is not known. We analyzed the relationship among biomarkers of inflammation (C-reactive protein [CRP]), hypercoagulability (d-dimer), and lung macrophage activation (ferritin), and the primary composite outcome of delirium/coma next day. We also measured associations between biomarkers and next day delirium and coma independently, and delirium severity. Retrospective, observational cohort study. ICUs at two large, urban, academic referral hospitals. All consecutive adult patients admitted to the ICU from March 1, 2020, to June 7, 2020, with COVID-19 with clinical biomarkers and delirium assessments performed. None. Daily concentrations of CRP, d-dimer, and ferritin were obtained. Coma (assessed by Richmond Agitation-Sedation Scale) and delirium (assessed by Confusion Assessment Method for the ICU/Confusion Assessment Method for the ICU-7) were measured bid. A cohort of 197 ICU patients with COVID-19 were included. Higher d-dimer (odds ratio [OR], 1.57; 95% CI, 1.17–2.12; p < 0.01) and ferritin quartiles (OR, 1.36; 95% CI, 1.02–1.81; p < 0.01) were associated with greater odds of the composite outcome of delirium/coma next day. d-dimer was associated with greater odds of next day delirium (OR, 1.49; 95% CI, 1.14–1.94; p < 0.01) and coma independently (OR, 1.52; 95% CI, 1.08–2.14; p = 0.017). Higher ferritin quartiles were associated with greater odds of next day delirium (OR, 1.33; 95% CI, 1.04–1.70; p = 0.026) and coma independently (OR, 1.59; 95% CI, 1.14–2.23; p < 0.01). Higher CRP quartiles were associated with coma (OR, 1.36; 95% CI, 1.03–1.79; p = 0.030) and delirium severity the next day (β = 0.30; se, 0.07; p ≤ 0.01). Our hypothesis-generating study found d-dimer and ferritin were associated with delirium/coma the following day, as well as delirium and coma independently. CRP was associated with next day coma and delirium severity. Larger studies to validate these results are needed.