Association between procalcitonin levels and duration of mechanical ventilation in COVID-19 patients.
Association between procalcitonin levels and duration of mechanical ventilation in COVID-19 patients.
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DOI：
10.1371/journal.pone.0239174
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Bartels K
中科院分区：
文献类型：
--
作者：
Krause M;Douin DJ;Tran TT;Fernandez-Bustamante A;Aftab M;Bartels K
确诊为COVID-19的患者经常需要机械通气。与长期需要机械通气相关的实验室检查知识可能会指导资源分配。我们假设血浆降钙素原水平升高（>0.1 ng/ml）与有创机械通气的持续时间相关。在2020年3月9日至4月20日期间被诊断为COVID-19的患者，在我们的卫生系统的任何医院住院，并需要有创机械通气，有资格参加这项观察性队列研究。从电子健康记录中获得人口统计学、合并症、序贯器官衰竭评估评分的组成部分和入院时的降钙素原水平。主要结局是机械通气的持续时间;次要结局包括28天死亡率和插管时间。结果在入院后的前28天内进行评估。通过描述性统计量总结基线人口统计学和合并症。单变量比较采用Pearson卡方检验（二元结局）和Mann-Whitney U检验（连续结局）。采用多元线性回归分析评估降钙素原水平与机械通气持续时间之间的相关性。在单变量分析中，初始降钙素原水平>0.1 ng/ml的患者需要的机械通气持续时间显著长于水平≤0.1 ng/ml的患者（p = 0.021）。两组之间的28天死亡率或插管时间无显著差异。在使用多变量线性回归进行校正分析后，初始降钙素原水平>0.1 ng/ml的患者的机械通气持续时间平均延长5.6（p = 0.016）天。在93名机械通气COVID-19患者的队列中，我们发现初始血浆降钙素原水平>0.1 ng/ml与机械通气持续时间之间存在相关性。这些发现可能有助于识别入院后长期机械通气的患者。
Patients diagnosed with COVID-19 frequently require mechanical ventilation. Knowledge of laboratory tests associated with the prolonged need for mechanical ventilation may guide resource allocation. We hypothesized that an elevated plasma procalcitonin level (>0.1 ng/ml) would be associated with the duration of invasive mechanical ventilation. Patients diagnosed with COVID-19, who were admitted to any of our health system’s hospitals between March 9th-April 20th, 2020 and required invasive mechanical ventilation, were eligible for this observational cohort study. Demographics, comorbidities, components of the Sequential Organ Failure Assessment score, and procalcitonin levels on admission were obtained from the electronic health record. The primary outcome was the duration of mechanical ventilation; secondary outcomes included 28-day mortality and time to intubation. Outcomes were assessed within the first 28 days of admission. Baseline demographics and comorbidities were summarized by descriptive statistics. Univariate comparisons were made using Pearson’s chi-square test for binary outcomes and Mann-Whitney U test for continuous outcomes. A multiple linear regression was fitted to assess the association between procalcitonin levels and the duration of mechanical ventilation. Patients with an initial procalcitonin level >0.1 ng/ml required a significantly longer duration of mechanical ventilation than patients with a level of ≤0.1 ng/ml (p = 0.021) in the univariate analysis. There was no significant difference in 28-day mortality or time to intubation between the two groups. After adjusted analysis using multivariable linear regression, the duration of mechanical ventilation was, on average, 5.6 (p = 0.016) days longer in patients with an initial procalcitonin level >0.1 ng/ml. In this cohort of 93 mechanically ventilated COVID-19 patients, we found an association between an initial plasma procalcitonin level >0.1 ng/ml and the duration of mechanical ventilation. These findings may help to identify patients at risk for prolonged mechanical ventilation upon admission.
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