Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.
Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.
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DOI：
10.1371/journal.pone.0246182
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Dreher M
中科院分区：
文献类型：
--
作者：
Balfanz P;Hartmann B;Müller-Wieland D;Kleines M;Häckl D;Kossack N;Kersten A;Cornelissen C;Müller T;Daher A;Stöhr R;Bickenbach J;Marx G;Marx N;Dreher M
部分2019冠状病毒病（COVID-19）患者会出现严重的临床病程，伴有急性呼吸窘迫综合征（ARDS）和致命结局。疾病早期阶段的临床表现和生物标志物对结局的相关预测影响在很大程度上仍未探索。我们的目的是确定亚组之间有显著差异的参数。分析了125名COVID-19患者。比较了ARDS患者（N = 59）和非ARDS患者（N = 66），以及两组的致死性结局与生存率。ARDS和非ARDS患者在并发症或药物治疗方面对致死性结局与生存率无差异。ARDS患者的体重指数高于非ARDS患者（p = 0.01），但存活者与非存活者之间无差异。ARDS患者入院时的白细胞介素-6水平高于非ARDS患者，致死性结局患者高于存活者，而淋巴细胞水平在不同亚组中均较低（所有p<0.05）。与存活者相比，非存活者的发热负荷有非常显著的3.5倍差异（p<0.0001）。与存活者相比，在具有致死性结局的患者中更常检测到肺外病毒传播（P = 0.01）。此外，血清中SARS-CoV-2的检测显示了更严重的病程和增加的死亡风险（均p<0.05）。我们已经确定了严重临床过程的早期风险标志物，如ARDS或致命性结局。这些数据可能有助于制定一项策略，以解决早期COVID-19患者和致命结局高风险患者的新治疗选择。
Some patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. Clinical manifestations and biomarkers in early stages of disease with relevant predictive impact for outcomes remain largely unexplored. We aimed to identify parameters which are significantly different between subgroups. 125 patients with COVID-19 were analysed. Patients with ARDS (N = 59) or non-ARDS (N = 66) were compared, as well as fatal outcome versus survival in the two groups. ARDS and non-ARDS patients did not differ with respect to comorbidities or medication on developing a fatal outcome versus survival. Body mass index was higher in patients with ARDS versus non-ARDS (p = 0.01), but not different within the groups in survivors versus non-survivors. Interleukin-6 levels on admission were higher in patients with ARDS compared to non-ARDS as well as in patients with fatal outcome versus survivors, whereas lymphocyte levels were lower in the different subgroups (all p<0.05). There was a highly significant 3.5-fold difference in fever load in non-survivors compared to survivors (p<0.0001). Extrapulmonary viral spread was detected more often in patients with fatal outcome compared to survivors (P = 0.01). Further the detection of SARS-CoV-2 in serum showed a significantly more severe course and an increased risk of death (both p<0.05). We have identified early risk markers for a severe clinical course, like ARDS or fatal outcome. This data might help develop a strategy to address new therapeutic options early in patients with COVID-19 and at high risk for fatal outcome.
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