新型冠状病毒肺炎患者入院时检验指标在病情严重程度中的预测价值

Predictive value of laboratory tests on severity of newly hospitalized patients with COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)患者入院时检验指标预测病情严重程度的价值。方法采用回顾性研究收集2020年1月27日至2月20日福建援鄂医疗队在武汉市金银潭医院工作期间经管的83例COVID-19确诊患者为研究对象,83例患者,男性54例,女性29例,年龄63(56~70)岁。并根据病情严重程度分为普通型、重型、危重型组,回顾性分析患者入院时的白细胞(WBC)、淋巴细胞(LYM)、乳酸脱氢酶(LDH)、白细胞介素-6(IL-6)、降钙素原(PCT)、血清铁蛋白(SF)、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)等指标,并采用Logistic回归分析各指标对危重型的预测价值。结果入院时普通型、重型、危重型组WBC(×109/L)分别为7.10±3.88、7.73±3.77、9.07±5.61(F=1.315,P=0.274),IL-6(μg/L)分别为11.76(9.42~15.18)、11.93(10.15~15.63)、11.24(8.06~13.75)(Z=0.591,P=0.744),D-D(mg/L)分别为0.70(0.48~1.12)、1.67(1.07~7.14)、1.96(0.71~8.18)(Z=3.363,P=0.186);入院时普通型、重型、危重型组LYM(×109/L)分别为1.10±0.33、0.80±0.35、0.66±0.32(F=11.415,P<0.001),SF(μg/L)分别为470.83±283.43、835.66±819.43、1341.15±949.54(F=7.98,P=0.001),ESR(mm/1 h)分别为30.76±15.70、42.55±22.51、51.04±25.09(F=5.181,P=0.008),LDH(U/L)分别为314.71±105.46、325.69±109.85、444.03±181.07(F=7.17,P=0.001),hs-CRP(μg/L)分别为16(7.20~19.90)、31.00(20.00~87.60)、80.50(33.70~113.00)(Z=12.185,P=0.002),PCT值(μg/L)分别为0.025(0.02~0.05)、0.05(0.02~0.13)、0.09(0.05~0.39)(Z=9.694,P=0.008)。普通型组LYM值高于重型和危重型组,危重型和重型组hs-CRP值高于普通型组,而危重型组SF、ESR、LDH和PCT高于重型和普通型组(P均<0.05)。结论入院时WBC、LYM、ESR、LDH等指标有助于判断COVID-19病情严重程度,IL-6水平虽有增高但对判断病情严重程度可能无意义。

Objective To analyze the laboratory tests in newly hospitalized patients with COVID-19 and their predictive values for the severity of the disease.Methods 83 patients,including 54 males and 29 females,with median interquartile range of 63(53-70)years diagnosed with covid-19 who were managed by Fujian medical team from January 27,2020 to February 20,2020 in Wuhan JinYinTan Hospital were studied retrospectively.According to the severity of the disease,they were divided into common,severe and critical groups.White blood cell(WBC),lymphocyte(LYM),loctate dehydrogenase(LDH),interleukin-6(IL-6),procalcitonin(PCT),serum ferritin(SF),erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP)and D-Dimer(D-D)on admission were analyzed retrospectively.And the predictive value of each indicator for critical group was analyzed by Logistic regression.Results On admission,in common,severe and critical groups,WBC(×109/L)values were 7.10±3.88,7.73±3.77 and 9.07±5.61,respectively(F=1.315,P=0.274);IL-6(μg/L)values were 11.76(9.42-15.18),11.93(10.15-15.63)and 11.24(8.06-13.75),respectively(Z=0.591,P=0.744);D-D(mg/L)values were 0.70(0.48-1.12),1.67(1.07-7.14)and 1.96(0.71-8.18),respectively(Z=3.363,P=0.186).There were no significant differences among three groups.On admission,in common,severe and critical groups,LYM(×109/L)values were 1.10±0.33,0.80±0.35 and 0.66±0.32,respectively(F=11.415,P<0.001);SF(μg/L)values were 470.83±283.43,835.66±819.43,and 1341.15±949.54,respectively(F=7.98,P=0.001);ESR(mm/h)values were 30.76±15.70,42.55±22.51 and 51.04±25.09,respectively(F=5.181,P=0.008);LDH(U/L)values were 314.71±105.46,325.69±109.85 and 444.03±181.07,respectively(F=7.17,P=0.001);hs-CRP(μg/L)values were 16(7.20-19.90),31.00(20.00-87.60)and 80.50(33.70-113.00),respectively(Z=12.185,P=0.002);PCT(μg/L)values were 0.025(0.02-0.05),0.05(0.02-0.13)and 0.09(0.05-0.39),respectively(Z=9.694,P=0.008).There were significant differences among three groups.Pairwise comparison showed that the LYM value in common group was higher than those in severe and critical groups,and the hs-CRP values in severe and critical groups were higher than that in common group,while SF,ESR,LDH and PCT values in critical group were all higher than those in severe and common groups(P<0.05).Conclusions On admission,WBC,LYM,ESR and LDH are helpful to predict the severity of COVID-19.Although the level of IL-6 is increased,it may not be meaningful to judge the severity of COVID-19.