C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early
C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early
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DOI：
10.1002/jmv.25871
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发表时间：
2020-04-25
影响因子：
12.7
通讯作者：
Li, Xiaosong
中科院分区：
文献类型：
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作者：
Tan, Chaochao;Huang, Ying;Li, Xiaosong
COVID-19已发展成为全球性大流行病，早期识别重症对于控制其并改善医疗资源有限的患者的预后至关重要。本研究旨在分析重症COVID-19的特征，并确定用于鉴别诊断和预后预测的生物标志物。总共回顾性入组了27名连续COVID-19患者和75名流感患者。从电子病历中收集临床参数。根据计算机断层扫描（CT）进展，将病程分为四个阶段：初始期、进展期、高峰期和恢复期。重度组淋巴细胞在病程进展期和高峰期进行性下降，恢复期回升。重症组在发病初期和进展期的C反应蛋白（CRP）水平均高于轻度组。相关分析显示CRP（R = .62; P < .01）、红细胞沉降率（R = .55; P < .01）和粒细胞/淋巴细胞比值（R = .49; P < .01）与CT严重程度评分呈正相关。相反，淋巴细胞数量（R =-0.37; P <0.01）与CT严重程度评分呈负相关。受试者操作特征分析表明，在20.42 mg/L临界值时，首次访视时CRP预测重度COVID-19的曲线下面积为0.87（95% CI 0.10-1.00），灵敏度和特异性分别为83%和91%。重症COVID-19患者的CRP在CT发现之前的初始阶段显著升高。重要的是，与疾病发展相关的CRP可以预测早期严重的COVID-19。
COVID-19 has developed into a worldwide pandemic; early identification of severe illness is critical for controlling it and improving the prognosis of patients with limited medical resources. The present study aimed to analyze the characteristics of severe COVID-19 and identify biomarkers for differential diagnosis and prognosis prediction. In total, 27 consecutive patients with COVID-19 and 75 patients with flu were retrospectively enrolled. Clinical parameters were collected from electronic medical records. The disease course was divided into four stages: initial, progression, peak, and recovery stages, according to computed tomography (CT) progress. to mild COVID-19, the lymphocytes in the severe COVID-19 progressively decreased at the progression and the peak stages, but rebound in the recovery stage. The levels of C-reactive protein (CRP) in the severe group at the initial and progression stages were higher than those in the mild group. Correlation analysis showed that CRP (R = .62; P < .01), erythrocyte sedimentation rate (R = .55; P < .01) and granulocyte/lymphocyte ratio (R = .49; P < .01) were positively associated with the CT severity scores. In contrast, the number of lymphocytes (R = -.37; P < .01) was negatively correlated with the CT severity scores. The receiver-operating characteristic analysis demonstrated that area under the curve of CRP on the first visit for predicting severe COVID-19 was 0.87 (95% CI 0.10-1.00) at 20.42 mg/L cut-off, with sensitivity and specificity 83% and 91%, respectively. CRP in severe COVID-19 patients increased significantly at the initial stage, before CT findings. Importantly, CRP, which was associated with disease development, predicted early severe COVID-19.