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[Lancet Rheumatol发表论文]:新冠肺炎相关高炎症反应与患者治疗升级:回顾纵向队列研究
2020年09月24日 时讯速递, 进展交流 暂无评论

COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study

Jessica J Manson, Colin Crooks, Meena Naja, et al

Lancet Rheumatol Published:August 21, 2020 DOI:https://doi.org/10.1016/S2665-9913(20)30275-7

Summary

Background 背景

A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival.

部分重度新冠肺炎患者发生高炎症综合征,引发较高的罹患率和病死率。本研究试图发现一种特异性表型,即新冠肺炎相关高炎症反应(COV-HI),及其与呼吸治疗升级和病死率增加的相关性。

Methods 方法

In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model.

在这项回顾性队列研究中,我们入选了英国第一波疫情期间University College London Hospitals 和 Newcastle upon Tyne Hospitals连续收治的PCR确诊新冠肺炎成年患者(年龄 ≥18 岁)。我们记录了人口统计学资料,以及从入院到死亡或出院期间的实验室检查及临床情况,最短随访时间28天。我们将COV-HI定义为CRP > 150 mg/L或24小时内升高一倍且> 50 mg/L,或铁蛋白水平> 1500 μg/L。我们将呼吸支持分为单纯氧疗,无创通气和有创通气。采用多水平logistic回归模型,根据初始及后续高炎症反应预测次日死亡风险或呼吸支持升级的需求(作为联合终点)。

Findings 结果

We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity.

我们纳入了2020年3月1日至3月31日期间参研医院收治的269名患者,其中178名 (66%) 患者符合呼吸支持升级,91名 (34%) 患者不符合。在整个队列中,90名 (33%) 患者入院时符合 COV-HI 标准。尽管入院时COV-HI患者中位年龄较小,Charlson合并症指数较低,但更多患者在随访期间死亡 (36/90 [40%] vs 46/179 [26%])。在 178 名需要完全呼吸支持的患者中,65名 (37%) 在入院时满足 COV-HI 的定义,呼吸支持升级的90名患者中67名 (74%) 在治疗升级当日满足上述标准。对年龄、性别和基础疾病进行校正后,满足 COV-HI 标准与次日呼吸治疗升级或死亡显著相关 (HR 2·24 [95% CI 1·62–2·87])。

Interpretation 结论

Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design.

新冠肺炎患者炎症标志物升高与呼吸支持升级及死亡的相关性,提示存在高危高炎症反应表型。COV-HI有助于试验设计时的患者分层。

Funding 资助

None.

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