C反应蛋白联合红细胞分布宽度检测对新型冠状病毒肺炎合并呼吸衰竭患者的临床预测价值

Clinical Predictive Value of C-Reactive Protein Combined with Erythrocyte Distribution Width Test in Patients with Novel Coronavirus Pneumonia Combined with Respiratory Failure

目的:探讨C反应蛋白联合红细胞分布宽度检测对新型冠状病毒肺炎(COVID-19)合并呼吸衰竭患者的临床预测价值。方法:回顾性纳入2022年12月至2023年1月于青岛大学附属医院就诊的COVID-19感染213例患者为研究对象,依据是否发生低氧血症和(或)高碳酸血症分为呼吸衰竭组(45例)和非呼吸衰竭组(168例),收集两组一般临床资料及实验室检查指标,通过单因素及多因素logistic回归分析两组之间的差异,构建受试者工作曲线(receiver operating characteristic, ROC)预测模型。结果:呼吸衰竭组慢性阻塞性肺疾病(COPD)病史、收缩压、白细胞计数、中性粒细胞计数、中性粒细胞计数/淋巴细胞计数(NLR)、红细胞分布宽度(RDW)、C-反应蛋白(CRP)、白细胞介素-6 (IL-6)、淋巴细胞计数、肾小球滤过率比较差异有统计学意义(P < 0.05);经多因素logistic回归分析示RDW (P < 0.05, 95%CI: 1.082, 2.246, OR = 1.559)、CRP (P < 0.05, 95%CI: 1.003, 1.027, OR = 1.015)是COVID-19合并呼吸衰竭患者的独立预测因子。两者联合的AUC为0.728 (95%CI为0.643~0.813,P < 0.01),最佳临界值为0.193,敏感度为78.6%,特异度为63.5%。结论:呼吸衰竭在COVID-19中并不少见,提示不良预后。CRP联合RDW检测有望作为评估新型冠状病毒肺炎合并呼吸衰竭简单易行的预测因子。

Objective: To investigate the clinical predictive value of C-reactive protein combined with erythro-cyte distribution width test in patients with novel coronavirus pneumonia combined with respira-tory failure. Methods: Retrospectively included 213 patients with COVID-19 infection who attended the Affiliated Hospital of Qingdao University from December 2022 to January 2023, and were di-vided into the respiratory failure group (45 patients) and the non-respiratory failure group (168 patients) according to whether hypoxemia and/or hypercapnia occurred, collected general clinical data and laboratory examination indexes of the two groups, and analyzed the differences between the two groups through univariate and multifactorial logistic regression to construct the ROC curve risk prediction models. Results: Comparison of chronic obstructive pulmonary disease history, sys-tolic blood pressure, white blood cell count, neutrophil count, NLR, RDW, CRP, IL-6, lymphocyte count, and glomerular filtration rate in the respiratory failure group showed statistically significant differences (P < 0.05);a multifactorial logistic regression analysis showed that RDW (P < 0.05, 95%CI: 1.082, 2.246, and OR = 1.559) and CRP (P < 0.05, 95%CI: 1.003, 1.027, OR = 1.015) were independent predictors of COVID-19 combined respiratory failure patients. The AUC of the combi-nation of the two was 0.728 (95% CI: 0.643~0.813, P < 0.01), with an optimal threshold of 0.193, a sensitivity of 78.6%, and a specificity of 63.5%. Conclusion: Respiratory failure is not uncommon in COVID-19 and suggests a poor prognosis. C-reactive protein combined with Erythrocyte distribution width assay is expected to be a simple and easy predictor for assessing respiratory failure in com-bination with novel coronavirus pneumonia.