血清胱抑素C对新型冠状病毒肺炎患者院内死亡的预测价值

Value of cystatin C level to predicting in-hospital mortality of patients with COVID-19

目的评价入院时胱抑素C(Cystatin C)水平对新型冠状病毒肺炎(COVID-19)患者住院死亡风险的预测价值。方法回顾性分析了2020年2月20日至2020年4月4日在雷神山医院实验室确诊的新型冠状病毒肺炎患者的临床资料,通过绘制受试者工作特征曲线(ROC)确定胱抑素C预测死亡的最佳截点值,根据最佳截点值将患者分为高胱抑素组和低胱抑素组,比较两组患者院内死亡率,评价胱抑素C的预测价值。结果本研究共有547例患者纳入本研究中,其中死亡30人。胱抑素C预测新型冠状病毒肺炎患者院内死亡的最佳截点值1.1 ng/mL,其敏感性87.1%、特异性77.3%;Kaplan-Meier生存曲线显示高胱抑素C水平患者的院内死亡率更高(χ^(2)=64.26,P<0.01);Cox比例风险回归分析表明,在调整混杂因素后,入院时胱抑素C水平仍是院内死亡的独立危险因素(HR 1.496,95%CI 1.130~1.982,P<0.01)。结论胱抑素C是一个有用的,简单的,廉价的生物学标记物,可以作为预测新型冠状病毒肺炎患者死亡的早期预警指标。

Objective To evaluate the value of cystatin C level at admission to predicting in-hospital mortality of patients with COVID-19.Methods The clinical data of patients with laboratory confirmed COVID-19 from February 20,2020 to April 4,2020 were retrospectively analyzed.Cystatin C level at admission,and death events were collected to calculate the optimum cut-off point by using receiver operating characteristic curve.According to the cut-off point,the subjects were divided into two groups.Then the in-hospital mortality between the two groups were compared to assess the predictive value of cystatin C level.Results A total of 547 eligible patients were enrolled in the study,and 30 death cases were included.The optimum cut-off value of cystatin C to predict in-hospital mortality was 1.1g/mL,with sensitivity of 87.1%and specificity of 77.3%.Kaplan-Meier survival curve showed a higher incidence of in-hospital mortality in patients with high cystatin C level at admission(χ^(2)=64.26,P<0.01).Cox proportional hazard analysis showed that cystatin C level was also a significant determinant(adjusted HR:1.496;95%CI:1.130-1.982,P<0.01)after adjustment of confounding factors.Conclusion Cystatin C level at admission is a useful,simple and inexpensive biological marker that can be used as an early warning indicator to predict in-hospital mortality in patients with COVID-19.