Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients
Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients
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DOI：
10.1016/j.ijantimicag.2020.106110
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发表时间：
2020-09-01
影响因子：
10.8
通讯作者：
Liu, Qingquan
中科院分区：
文献类型：
--
作者：
Cheng, Anying;Hu, Liu;Liu, Qingquan
2019冠状病毒病（COVID-19）肺炎危重病例粗死亡率达49%。本研究旨在测试血尿素氮（BUN）水平与d -二聚体的结合是否可预测COVID-19患者住院死亡率。分析305例新冠肺炎患者的临床特征，并将生存组与非生存组进行比较。305例患者中死亡85例（27.9%），出院220例（72.1%）。与出院患者相比，未存活患者年龄较大，BUN和d -二聚体水平显著高于出院患者（P < 0.01）。最小绝对收缩和选择算子（LASSO）和多变量Cox回归分析发现BUN和d -二聚体水平是预后不良的独立危险因素。Kaplan-Meier分析显示，BUN和d -二聚体水平升高与死亡率增加相关（logrank, P 0.01）。BUN联合d -二聚体的曲线下面积为0.94 (95% CI 0.90 ~ 0.97)，敏感性为85%，特异性为91%。基于入院时BUN和d -二聚体水平，建立了判别性较好的nomogram模型，一致性指数为0.94。总之，初始BUN和d -二聚体水平与COVID-19患者的死亡率相关。BUN 4.6 mmol/L和d -二聚体> 0.845 mu g/mL联合检测似乎可以识别院内死亡高危患者，因此可能被证明是COVID-19重症患者强有力的风险评估工具。(c) 2020 Elsevier B.V.和国际化学疗法学会。版权所有。
The crude mortality rate in critical pneumonia cases with coronavirus disease 2019 (COVID-19) reaches 49%. This study aimed to test whether levels of blood urea nitrogen (BUN) in combination with D-dimer were predictors of in-hospital mortality in COVID-19 patients. The clinical characteristics of 305 COVID19 patients were analysed and were compared between the survivor and non-survivor groups. Of the 305 patients, 85 (27.9%) died and 220 (72.1%) were discharged from hospital. Compared with discharged cases, non-survivor cases were older and their BUN and D-dimer levels were significantly higher ( P < 0.0 0 01). Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regression analyses identified BUN and D-dimer levels as independent risk factors for poor prognosis. Kaplan-Meier analysis showed that elevated levels of BUN and D-dimer were associated with increased mortality (logrank, P 0.0 0 01). The area under the curve for BUN combined with D-dimer was 0.94 (95% CI 0.90-0.97), with a sensitivity of 85% and specificity of 91%. Based on BUN and D-dimer levels on admission, a nomogram model was developed that showed good discrimination, with a concordance index of 0.94. Together, initial BUN and D-dimer levels were associated with mortality in COVID-19 patients. The combination of BUN 4.6 mmol/L and D-dimer > 0.845 mu g/mL appears to identify patients at high risk of in-hospital mortality, therefore it may prove to be a powerful risk assessment tool for severe COVID-19 patients. (c) 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.