Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort
Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort
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DOI：
10.1016/j.cmi.2020.06.033
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发表时间：
2020-10-01
影响因子：
14.2
通讯作者：
Deng, A.
中科院分区：
文献类型：
--
作者：
Cheng, B.;Hu, J.;Deng, A.
目的：2019年冠状病毒病(新冠肺炎)大多数病例被确定为中度，其定义为发热或干咳，肺部显像伴有磨玻璃样阴影。研究对象为2020年1月1日至3月20日在武汉市中心医院中国住院的中度新冠肺炎患者，其危险因素和预后预测因素尚不明确。结果：在纳入的中度新冠肺炎患者中，251/456(55.0%)患者预后不良。多因素Logistic回归分析显示，中性粒细胞计数、入院时淋巴细胞计数比(OR 1.032，95%CI 1.042~1.230，p 0.004)和入院时C反应蛋白升高(OR 3.017，95%CI 1.941~4.690，p<；0.001)与预后不良的OR增加有关。预测病情进展的受试者工作特征曲线下面积分别为0.77(95%CI 0.694~0.846，p&t；0.001)和0.84(95%CI 0.780~0.905，p<；0.001)，临界值分别为2.79和25.95 mg/L。预测死亡的AUC值分别为0.81(95%CI 0.732~0.878，p<；0.001)和0.89(95%CI 0.825~0.946，p<；0.001)，其临界值分别为3.19和33.4 mg/L。NLR和CRP是进展到危重状态和死亡的良好预测指标。(C)2020年欧洲临床微生物学和传染病学会。爱思唯尔有限公司出版。保留所有权利。
Objective: Most cases of coronavirus disease 2019 (COVID-19) are identified as moderate, which is defined as having a fever or dry cough and lung imaging with ground-glass opacities. The risk factors and predictors of prognosis in such cohorts remain uncertain.Methods: All adults with COVID-19 of moderate severity diagnosed using quantitative RT-PCR and hospitalized at the Central Hospital of Wuhan, China, from 1 January to 20 March 2020 were enrolled in this retrospective study. The main outcomes were progression from moderate to severe or critical condition or death.Results: Among the 456 enrolled patients with moderate COVID-19, 251/456 (55.0%) had poor prognosis. Multivariate logistic regression analysis identified higher neutrophil count: lymphocyte count ratio (NLR) on admission (OR 1.032, 95% CI 1.042-1.230, p 0.004) and higher C-reactive protein (CRP) on admission (OR 3.017, 95% CI 1.941-4.690, p < 0.001) were associated with increased OR of poor prognosis. The area under the receiver operating characteristic curve (AUC) for NLR and CRP in predicting progression to critical condition was 0.77 (95% CI 0.694-0.846, p < 0.001) and 0.84 (95% CI 0.780-0.905, p < 0.001), with a cut-off value of 2.79 and 25.95 mg/L, respectively. The AUC of NLR and CRP in predicting death was 0.81 (95% CI 0.732-0.878, p < 0.001) and 0.89 (95% CI 0.825-0.946, p < 0.001), with a cut-off value of 3.19 and 33.4 mg/L, respectively.Conclusions: Higher levels of NLR and CRP at admission were associated with poor prognosis of individuals with moderate COVID-19. NLR and CRP were good predictors of progression to critical condition and death. (C) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.