新型冠状病毒感染者入院时血清降钙素原、白细胞介素-6和白细胞介素-8水平及其在患者预后中的意义

Serum levels of procalcitonin,interleukin⁃6 and interleukin⁃8 in patients with COVID⁃19 infection at admission and their significance in patient prognosis

目的分析患者入院时血清降钙素原(PCT)和细胞因子水平对新型冠状病毒感染者(COVID-19)预后的预测价值。方法纳入2022年11月至2023年2月首都医科大学附属北京胸科医院收治的确诊COVID-19,采用化学发光法检测血清PCT水平,流式微球阵列法检测血清细胞因子IL-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-17A、IL-17F、IL-22、TNF-α、TNF-β、IFN-γ水平。将入住ICU、接受机械通气和院内死亡定义为预后不良,排除合并细菌感染的患者后,分析入院时血清中PCT和细胞因子水平与COVID-19患者预后的关系。结果共纳入176例资料完整的患者,其中PCT正常组134例,PCT升高组42例,中位年龄为71.50岁,男性占71.59%。PCT升高组患者ICU入住率(38.41%vs.13.11%,P<0.05)、机械通气率(76.92%vs.24.59%,P<0.001)和院内死亡率(38.46%vs.6.56%,P<0.001)均显著高于PCT正常组。预后不良患者血清中细胞因子IL-6(7.40 pg/mL vs.4.78 pg/mL,P<0.05)和IL-8(10.97 pg/mL vs.5.92 pg/mL,P<0.001)的水平显著高于预后良好者。根据ROC曲线计算,PCT、IL-6和IL-8预测COVID-19患者预后不良的曲线下面积分别为0.687、0.660和0.746;灵敏度分别为52.78%、55.17%和72.41%;特异度分别为81.58%、74.19%和74.19%。当PCT、IL-6和IL-8联合预测COVID-19患者预后时,曲线下面积为0.764,灵敏度为70.00%,特异度为80.00%。结论血清PCT和细胞因子IL-6、IL-8可作为COVID-19患者预后不良的预测标志物。

Objective To analyze the predictive value of serum levels of procalcitonin(PCT)and cytokines on the prognosis of patients with COVID⁃19 at admission.Methods From November 2022 to February 2023,patients diagnosed with COVID⁃19 who were admitted to Beijing Chest Hospital were enrolled.Chemiluminescence was used to detect serum PCT levels,and flow microsphere array was used to detect serum cytokines IL⁃1β,IL⁃2,IL⁃4,IL⁃5,IL⁃6,IL⁃8,IL⁃10,IL⁃12p70,IL⁃17A,IL⁃17F,IL⁃22,TNF⁃α,TNF⁃β,IFN⁃γlevel.ICU admission,mechanical ventilation and in⁃hospital death were defined as poor prognosis.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID⁃19 patients was analyzed.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID⁃19 patients was analyzed.Results A total of 176 patients with complete data were included,including 134 in the PCT⁃normal group and 42 in the PCT⁃elevated group,with a median age of 71.50 years and 71.59%males.Patients in the PCT elevated⁃group had significantly higher rates of ICU admission(38.41%vs.13.11%,P<0.05),mechanical ventilation(76.92%vs.24.59%,P<0.001)and in⁃hospital mortality(38.46%vs.6.56%,P<0.001)were significantly higher than those in the PCT⁃normal group.Serum levels of cytokines IL⁃6(7.40 pg/mL vs.4.78 pg/mL,P=0.0334)and IL⁃8(10.97 pg/mL vs.5.92 pg/mL,P<0.001)were significantly higher in patients with poor prognosis than in those with good prognosis.The area under the curve for PCT,IL⁃6,and IL⁃8 to predict poor prognosis in COVID⁃19 patients was 0.687,0.660,and 0.746,respectively;sensitivity was 52.78%,55.17%,and 72.41%,respectively;and specificity was 81.58%,74.19%,and 74.19%,respectively,as calculated from the ROC curve.When PCT,IL⁃6 and IL⁃8 jointly predict the prognosis of COVID⁃19 patients,the area under the curve is 0.764,the sensitivity is 70.00%,and the specificity is 80.00%.Conclusion Serum PCT and cytokines IL⁃6 and IL⁃8 could be used as predictive markers for poor prognosis in patients with COVID⁃19.