Study on early laboratory warning of severe COVID-19

doi:10.3969/j.issn.1673-8640.2020.06.009

Abstract

Abstract:

Objective To evaluate the predictive role of early laboratory indicators in the severity of corona virus disease 2019（COVID-19）. Methods Retrospective analysis was used to analyze the laboratory results in 85 patients with COVID-19 at the time of admission,and the results included blood routine test,liver function,kidney function,blood coagulation function,interleukin 6（IL-6）,ferritin,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,procalcitonin（PCT）,myoglobin,troponin and amyloid A. Results In severe group,the levels of white blood cell（WBC） count,the absolute value of neutrophil（NEUT#）,neutrophil-lymphocyte ratio（NLR）,lactate dehydrogenase（LDH）,CRP,D-dimer（DD）,ferritin and creatinine were higher than those in mild group（P<0.05）. WBC count,NEUT#,NLR,LDH,myoglobin,CRP and ferritin were predictive risk factors of COVID-19. NLR was an independent predictor for the severity of COVID-19. When the cut-off value of NLR was 5.61,the sensitivity and specificity were 68.75% and 78.38%,respectively. Conclusions The increasing of WBC count,NEUT#,NLR,LDH,myoglobin,CRP and ferritin suggests the risk of severity,and NLR is an independent prediction for the severity of COVID-19.

Key words: Corona virus disease 2019, Predictive factor, Neutrophil-lymphocyte ratio

CLC Number:

R446.1

ZHA Qiongfang, FENG Bo, LI Xiaoning, ZHOU Donghua, KANG Yu, QIN Hui. Study on early laboratory warning of severe COVID-19[J]. Laboratory Medicine, 2020, 35(6): 557-560.

Figures/Tables 3

References 8

[1]	国家卫生健康委办公厅. 新型冠状病毒肺炎诊疗方案(试行第六版) [EB/OL]. (2020-02-18)[2020-02-25]. .
[2]	湖北省卫生健康委. 武汉市卫健委关于当前我市肺炎疫情的情况通报[EB/OL].(2019-12-31)[2020-02-25]. .
[3]	孟欣,胡辽辽,张宁,等. 中性粒细胞/淋巴细胞比值在甲、乙型流感病毒感染患者预测价值分析[J]. 国际检验医学杂志,2019,40(20):2464-2467.
[4]	蒋小燕,梁敏,李英. 中性粒细胞与淋巴细胞比值对预测ICU患者病原菌感染的临床价值分析[J]. 实用医院临床杂志,2019,16(6):41-43.
[5]	陈倩倩,霍建民. 中性粒细胞与淋巴细胞比值和CAP严重程度评分的相关性研究[J]. 临床肺科杂志,2020,25(1):34-39.
[6]	SOYLU K,GEDIKLI Ö,EKI A,et al.Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism[J]. Arch Med Sci,2016,12(1):95-100.
[7]	ÌN E,KULUÖZTÜRK M,ÖNER Ö,et al. The importance of neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease[J]. Turk Thorac J,2016,17(2):41-46.
[8]	周瑜,代艳梅,王一平,等. 老年重症肺炎患者细胞炎性因子、凝血功能情况及预后的影响因素分析[J]. 临床肺科杂志,2020,25(1):70-73.

项目	普通型	重症型	P值
WBC计数/（×10⁹/L）	6.17±3.26	12.25±10.55	0.000
NEUT#/（×10⁹/L）	4.74±3.18	15.31±21.26	0.001
淋巴细胞绝对数/（×10⁹/L）	1.45±3.16	1.09±1.13	0.513
NLR	6.31±6.35	16.45±11.73	0.000
丙氨酸氨基转移酶/（U/L）	41.04±24.77	42.62±30.30	0.792
LDH/（U/L）	329.8±139.46	504.67±236.61	0.000
肌红蛋白/（ng/mL）	54.32±35.99	131.92±244.50	0.052
肌钙蛋白/（pg/mL）	6.43±9.26	260.97±1312.52	0.196
PCT/（ng/mL）	0.07±0.05	1.74±7.24	0.121
CRP/（mg/L）	55.23±54.21	113.85±77.22	0.000
ESR/（mm/h）	48.77±23.15	52.52±23.42	0.497
DD/（μg/mL）	3.22±9.11	9.92±18.57	0.041
纤维蛋白原/（g/L）	5.40±5.54	5.64±2.26	0.816
IL-6/（pg/mL）	8.40±3.39	9.99±4.48	0.108
铁蛋白/（ng/mL）	814.07±602.65	1398.30±609.31	0.001
淀粉样蛋白A/（mg/L）	186.35±104.10	212.98±79.34	0.209
肌酐/（μmol/L）	70.26±18.03	116.95±149.95	0.035
胱抑素C/（mg/L）	0.90±0.25	1.02±0.34	0.054

项目	普通型	重症型	P值
WBC计数/（×10⁹/L）	6.17±3.26	12.25±10.55	0.000
NEUT#/（×10⁹/L）	4.74±3.18	15.31±21.26	0.001
淋巴细胞绝对数/（×10⁹/L）	1.45±3.16	1.09±1.13	0.513
NLR	6.31±6.35	16.45±11.73	0.000
丙氨酸氨基转移酶/（U/L）	41.04±24.77	42.62±30.30	0.792
LDH/（U/L）	329.8±139.46	504.67±236.61	0.000
肌红蛋白/（ng/mL）	54.32±35.99	131.92±244.50	0.052
肌钙蛋白/（pg/mL）	6.43±9.26	260.97±1312.52	0.196
PCT/（ng/mL）	0.07±0.05	1.74±7.24	0.121
CRP/（mg/L）	55.23±54.21	113.85±77.22	0.000
ESR/（mm/h）	48.77±23.15	52.52±23.42	0.497
DD/（μg/mL）	3.22±9.11	9.92±18.57	0.041
纤维蛋白原/（g/L）	5.40±5.54	5.64±2.26	0.816
IL-6/（pg/mL）	8.40±3.39	9.99±4.48	0.108
铁蛋白/（ng/mL）	814.07±602.65	1398.30±609.31	0.001
淀粉样蛋白A/（mg/L）	186.35±104.10	212.98±79.34	0.209
肌酐/（μmol/L）	70.26±18.03	116.95±149.95	0.035
胱抑素C/（mg/L）	0.90±0.25	1.02±0.34	0.054

项目	P值	Exp（B）	95%可信区间
项目	P值	Exp（B）	上限	下限
WBC计数/（×10⁹/L）	0.004	1.230	1.069	1.414
NEUT#/（×10⁹/L）	0.003	1.245	1.075	1.442
淋巴细胞绝对数/（×10⁹/L）	0.540	0.929	0.733	1.176
NLR	0.000	1.134	1.061	1.213
丙氨酸氨基转氨酶/（U/L）	0.789	1.002	0.986	1.018
LDH/（U/L）	0.001	1.006	1.003	1.009
肌红蛋白/（ng/mL）	0.047	1.015	1.000	1.029
肌钙蛋白/（pg/mL）	0.051	1.047	1.000	1.096
PCT/（ng/mL）	0.067	1308	0.608	2 814 000.000
CRP/（mg/L）	0.001	1.013	1.006	1.021
ESR/（mm/h）	0.491	1.007	0.987	1.028
DD/（μg/mL）	0.078	1.041	0.995	1.089
纤维蛋白原/（g/L）	0.814	1.012	0.915	1.120
IL-6/（pg/mL）	0.115	1.112	0.974	1.269
铁蛋白/（ng/mL）	0.002	1.001	1.001	1.002
淀粉样蛋白A/（mg/L）	0.208	1.003	0.998	1.008
肌酐/（μmol/L）	0.227	1.009	0.994	1.024
胱抑素C/（mg/L）	0.063	4.703	0.920	24.043

项目	P值	Exp（B）	95%可信区间
项目	P值	Exp（B）	上限	下限
WBC计数/（×10⁹/L）	0.004	1.230	1.069	1.414
NEUT#/（×10⁹/L）	0.003	1.245	1.075	1.442
淋巴细胞绝对数/（×10⁹/L）	0.540	0.929	0.733	1.176
NLR	0.000	1.134	1.061	1.213
丙氨酸氨基转氨酶/（U/L）	0.789	1.002	0.986	1.018
LDH/（U/L）	0.001	1.006	1.003	1.009
肌红蛋白/（ng/mL）	0.047	1.015	1.000	1.029
肌钙蛋白/（pg/mL）	0.051	1.047	1.000	1.096
PCT/（ng/mL）	0.067	1308	0.608	2 814 000.000
CRP/（mg/L）	0.001	1.013	1.006	1.021
ESR/（mm/h）	0.491	1.007	0.987	1.028
DD/（μg/mL）	0.078	1.041	0.995	1.089
纤维蛋白原/（g/L）	0.814	1.012	0.915	1.120
IL-6/（pg/mL）	0.115	1.112	0.974	1.269
铁蛋白/（ng/mL）	0.002	1.001	1.001	1.002
淀粉样蛋白A/（mg/L）	0.208	1.003	0.998	1.008
肌酐/（μmol/L）	0.227	1.009	0.994	1.024
胱抑素C/（mg/L）	0.063	4.703	0.920	24.043

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