MuLBSTA评分联合炎症指标对新型冠状病毒肺炎患者不良结局预测价值

Prediction value of the combination of MuLBSTA score and inflammatory markers on poor outcomes in patients with COVID-19

目的探索MuLBSTA评分联合炎症指标对新型冠状病毒肺炎(COVID-19)患者不良预后预测和诊断的准确性,为临床诊疗提供参考。方法采用回顾性、病例对照方法,纳入武汉市中心医院后湖院区3个救治病区2020年2月25日至3月20日之间符合研究标准的COVID-19患者。收集患者入院时的临床参数和结局参数,按住院期间是否发生不良结局将患者分为非不良结局组与不良结局组。比较两组患者的临床参数,单因素及多因素logistic回归分析筛选不良结局的危险因素。作各独立危险因素与不良结局诊断的ROC曲线,计算曲线下面积(AUC)。将各危险因素进行搭配组合,比较各组合方案AUC的差异。结果共83例患者纳入研究,12例(14.4%)患者出现不良结局,其中5例(6.0%)院内死亡。logistic多因素回归分析筛选出4个不良结局危险因素,分别为:MuLBSTA评分≥9分,OR(95%CI):180.46(4.46~7297.26);IL-6≥100 pg/mL,OR(95%CI):47.24(2.86~779.30);肺实变或胸腔积液,OR(95%CI):44.68(1.68~1182.96);CRP≥5 mg/dL,OR(95%CI):15.32(1.03~227.89)。ROC曲线分析表明:MuLBSTA评分+炎症指标(IL-6+CRP)+肺实变或胸腔积液方案的组合具有对不良结局诊断最高的AUC值(0.98)。MuLBSTA评分和炎症指标组合后各自的AUC值均显著提高。结论MuLBSTA评分、炎症指标和肺实变或胸腔积液均是COVID-19患者不良预后独立相关因素,联合炎症指标可以显著提高MuLBSTA评分对COVID-19患者不良预后的预测准确性。

Objective To investigate the accuracy of the combination of MuLBSTA score and inflammatory markers in the prediction of poor outcomes in patients with COVID-19,so as to provide reference for clinical diagnosis and treatment.Methods Retrospective and case-control methods were used to enroll COVID-19 patients who met research criteria from February 25 to March 20,2020 in three treatment wards of Houhu Branch of Wuhan Central Hospital.Clinical parameters at admission and outcome parameters of patients were collected,and patients were divided into non adverse outcome group and adverse outcome group according to whether or not adverse outcomes occurred during hospitalization.The clinical parameters of the two groups were compared,and the risk factors for adverse outcomes were screened by univariate and multivariate logistic regression analysis.The ROC curve of each independent risk factor and adverse outcome diagnosis was made,and the area under the curve(AUC)was calculated.The risk factors were matched and combined,and the AUC difference of each combination scheme was compared.Results A total of 83 patients were included in the study.12 patients(14.4%)had adverse outcomes,of which 5(6.0%)died in hospital.Four risk factors for adverse outcomes were screened by logistic regression analysis,which included MuLBSTA score≥9,OR(95%CI):180.46(4.46-7297.26);IL-6≥100 pg/mL,OR(95%CI):47.24(2.86-779.30);pulmonary consolidation or pleural effusion,OR(95%CI):44.68(1.68-1182.96);CRP≥5 mg/dL,OR(95%CI):15.32(1.03-227.89).ROC curve analysis showed that the combination of MuLBSTA score+inflammatory markers(IL-6+CRP)+pulmonary consolidation or pleural effusion had the highest AUC value for poor outcomes(0.98).After combining MuLBSTA score with inflammatory markers,their AUC values significantly improved.Conclusion MulBSTA score,inflammatory markers and pulmonary consolidation or pleural effusion are independent risk factors of poor outcomes of patients with COVID-19.MuLBSTA score can significantly improve the prediction accuracy of poor outcomes while combining with inflammatory markers.