Use of predictive tools in the management of COVID-19 patients: a key role of clinical laboratories.
Use of predictive tools in the management of COVID-19 patients: a key role of clinical laboratories.
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DOI：
10.1515/almed-2020-0059
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发表时间：
2021-05
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2019冠状病毒病（COVID-19）正在广泛传播，对全球健康构成严重威胁。在抗击这一大流行病的斗争中，省级医院迫切需要对COVID-19感染患者进行快速诊断，以避免急诊室崩溃。然而，严重急性呼吸道症状患者的高需求限制了通过金标准方法逆转录-聚合酶链反应（rRT-PCR）真实的时间鉴定COVID-19阳性肺炎的快速交付结果。主要目的是寻找其他有用的实验室指标，以协助rRT-PCR检测，并帮助控制这种疫情。从总共309例患者中收集血液、凝血和炎症参数，分为阴性（128例）和阳性（181例）rRT-PCR试验组。分子诊断试验将患者归类为阳性。两组患者的白细胞计数（WBC）、中性粒细胞计数、淋巴细胞计数和乳酸脱氢酶（LDH）差异有统计学意义。LDH/WBC比值的使用提高了诊断性能，具有最佳曲线下面积（0.783），灵敏度（82%）和正确识别COVID-19阳性患者的最佳百分比（80.5%）。预测LDH/WBC比值与临床疾病特征的结合有助于患者的医疗管理，并改善医院的技术资源，特别是在医疗设备严重短缺和缺乏进行rRT-PCR的试剂的关键情况下。
Coronavirus disease 2019 (COVID-19) is widely spreading and represents a critical threat to global health. In the fight against this pandemic, provincial hospitals urgently need rapid diagnostic of COVID-19 infected patients to avoid collapsing of emergency units. However, the high demand of patients with severe acute respiratory symptoms limits the fast delivery of results by the gold standard method reverse transcription-polymerase chain reaction real time (rRT-PCR) for the identification of COVID-19 positive pneumonia. The principal aim is to find other useful laboratory indicators to assist rRT-PCR tests and to help controlling of this outbreak. Blood, coagulation and inflammatory parameters were collected from a total of 309 patients classified as negative (128) and positive (181) rRT-PCR test groups. Patients were classified as positive by molecular diagnostic test. Leukocyte count (WBC), neutrophils count, lymphocytes count and lactate dehydrogenase (LDH) were statistically different between both groups of patients. The use of LDH/WBC ratio increases the diagnostic performance with the best area under the curve (0.783), sensibility (82%) and the best percentage (80.5%) of correctly identified COVID-19 positive patients. The combination of predictive LDH/WBC ratio with clinical illness features could help in medical management of patients and improve the technical resources of hospitals, especially in a critical scenario with a large shortage of medical equipment and lack of reagents for performing rRT-PCR.