{"id":19266,"date":"2020-09-24T04:51:50","date_gmt":"2020-09-23T20:51:50","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19266"},"modified":"2020-09-26T07:27:50","modified_gmt":"2020-09-25T23:27:50","slug":"19266","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19266","title":{"rendered":"[Lancet Rheumatol\u53d1\u8868\u8bba\u6587]\uff1a\u65b0\u51a0\u80ba\u708e\u76f8\u5173\u9ad8\u708e\u75c7\u53cd\u5e94\u4e0e\u60a3\u8005\u6cbb\u7597\u5347\u7ea7\uff1a\u56de\u987e\u7eb5\u5411\u961f\u5217\u7814\u7a76"},"content":{"rendered":"\n

COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study<\/h1>\n\n\n\n

Jessica J Manson, Colin Crooks, Meena Naja,\u00a0et al<\/h3>\n\n\n\n

Lancet Rheumatol Published:August 21, 2020 DOI:https:\/\/doi.org\/10.1016\/S2665-9913(20)30275-7<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background \u80cc\u666f<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u90e8\u5206\u91cd\u5ea6\u65b0\u51a0\u80ba\u708e\u60a3\u8005\u53d1\u751f\u9ad8\u708e\u75c7\u7efc\u5408\u5f81\uff0c\u5f15\u53d1\u8f83\u9ad8\u7684\u7f79\u60a3\u7387\u548c\u75c5\u6b7b\u7387\u3002\u672c\u7814\u7a76\u8bd5\u56fe\u53d1\u73b0\u4e00\u79cd\u7279\u5f02\u6027\u8868\u578b\uff0c\u5373\u65b0\u51a0\u80ba\u708e\u76f8\u5173\u9ad8\u708e\u75c7\u53cd\u5e94(COV-HI)\uff0c\u53ca\u5176\u4e0e\u547c\u5438\u6cbb\u7597\u5347\u7ea7\u548c\u75c5\u6b7b\u7387\u589e\u52a0\u7684\u76f8\u5173\u6027\u3002<\/p>\n\n\n\n

Methods \u65b9\u6cd5<\/h3>\n\n\n\n

In this retrospective cohort study, we enrolled consecutive inpatients (aged \u226518 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 \u03bcg\/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.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u56de\u987e\u6027\u961f\u5217\u7814\u7a76\u4e2d\uff0c\u6211\u4eec\u5165\u9009\u4e86\u82f1\u56fd\u7b2c\u4e00\u6ce2\u75ab\u60c5\u671f\u95f4University College London Hospitals \u548c Newcastle upon Tyne Hospitals\u8fde\u7eed\u6536\u6cbb\u7684PCR\u786e\u8bca\u65b0\u51a0\u80ba\u708e\u6210\u5e74\u60a3\u8005\uff08\u5e74\u9f84 \u226518 \u5c81\uff09\u3002\u6211\u4eec\u8bb0\u5f55\u4e86\u4eba\u53e3\u7edf\u8ba1\u5b66\u8d44\u6599\uff0c\u4ee5\u53ca\u4ece\u5165\u9662\u5230\u6b7b\u4ea1\u6216\u51fa\u9662\u671f\u95f4\u7684\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u53ca\u4e34\u5e8a\u60c5\u51b5\uff0c\u6700\u77ed\u968f\u8bbf\u65f6\u95f428\u5929\u3002\u6211\u4eec\u5c06COV-HI\u5b9a\u4e49\u4e3aCRP > 150 mg\/L\u621624\u5c0f\u65f6\u5185\u5347\u9ad8\u4e00\u500d\u4e14> 50 mg\/L\uff0c\u6216\u94c1\u86cb\u767d\u6c34\u5e73> 1500 \u03bcg\/L\u3002\u6211\u4eec\u5c06\u547c\u5438\u652f\u6301\u5206\u4e3a\u5355\u7eaf\u6c27\u7597\uff0c\u65e0\u521b\u901a\u6c14\u548c\u6709\u521b\u901a\u6c14\u3002\u91c7\u7528\u591a\u6c34\u5e73logistic\u56de\u5f52\u6a21\u578b\uff0c\u6839\u636e\u521d\u59cb\u53ca\u540e\u7eed\u9ad8\u708e\u75c7\u53cd\u5e94\u9884\u6d4b\u6b21\u65e5\u6b7b\u4ea1\u98ce\u9669\u6216\u547c\u5438\u652f\u6301\u5347\u7ea7\u7684\u9700\u6c42\uff08\u4f5c\u4e3a\u8054\u5408\u7ec8\u70b9\uff09\u3002<\/p>\n\n\n\n

Findings \u7ed3\u679c<\/h3>\n\n\n\n

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\u00b724 [95% CI 1\u00b762\u20132\u00b787]) after adjustment for age, sex, and comorbidity.<\/p>\n\n\n\n

\u6211\u4eec\u7eb3\u5165\u4e862020\u5e743\u67081\u65e5\u81f33\u670831\u65e5\u671f\u95f4\u53c2\u7814\u533b\u9662\u6536\u6cbb\u7684269\u540d\u60a3\u8005\uff0c\u5176\u4e2d178\u540d (66%) \u60a3\u8005\u7b26\u5408\u547c\u5438\u652f\u6301\u5347\u7ea7\uff0c91\u540d (34%) \u60a3\u8005\u4e0d\u7b26\u5408\u3002\u5728\u6574\u4e2a\u961f\u5217\u4e2d\uff0c90\u540d (33%) \u60a3\u8005\u5165\u9662\u65f6\u7b26\u5408 COV-HI \u6807\u51c6\u3002\u5c3d\u7ba1\u5165\u9662\u65f6COV-HI\u60a3\u8005\u4e2d\u4f4d\u5e74\u9f84\u8f83\u5c0f\uff0cCharlson\u5408\u5e76\u75c7\u6307\u6570\u8f83\u4f4e\uff0c\u4f46\u66f4\u591a\u60a3\u8005\u5728\u968f\u8bbf\u671f\u95f4\u6b7b\u4ea1 (36\/90 [40%] vs 46\/179 [26%])\u3002\u5728 178 \u540d\u9700\u8981\u5b8c\u5168\u547c\u5438\u652f\u6301\u7684\u60a3\u8005\u4e2d\uff0c65\u540d (37%) \u5728\u5165\u9662\u65f6\u6ee1\u8db3 COV-HI \u7684\u5b9a\u4e49\uff0c\u547c\u5438\u652f\u6301\u5347\u7ea7\u768490\u540d\u60a3\u8005\u4e2d67\u540d (74%) \u5728\u6cbb\u7597\u5347\u7ea7\u5f53\u65e5\u6ee1\u8db3\u4e0a\u8ff0\u6807\u51c6\u3002\u5bf9\u5e74\u9f84\u3001\u6027\u522b\u548c\u57fa\u7840\u75be\u75c5\u8fdb\u884c\u6821\u6b63\u540e\uff0c\u6ee1\u8db3 COV-HI \u6807\u51c6\u4e0e\u6b21\u65e5\u547c\u5438\u6cbb\u7597\u5347\u7ea7\u6216\u6b7b\u4ea1\u663e\u8457\u76f8\u5173 (HR 2\u00b724 [95% CI 1\u00b762\u20132\u00b787])\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation \u7ed3\u8bba<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u65b0\u51a0\u80ba\u708e\u60a3\u8005\u708e\u75c7\u6807\u5fd7\u7269\u5347\u9ad8\u4e0e\u547c\u5438\u652f\u6301\u5347\u7ea7\u53ca\u6b7b\u4ea1\u7684\u76f8\u5173\u6027\uff0c\u63d0\u793a\u5b58\u5728\u9ad8\u5371\u9ad8\u708e\u75c7\u53cd\u5e94\u8868\u578b\u3002COV-HI\u6709\u52a9\u4e8e\u8bd5\u9a8c\u8bbe\u8ba1\u65f6\u7684\u60a3\u8005\u5206\u5c42\u3002<\/p>\n\n\n\n

Funding \u8d44\u52a9<\/h3>\n\n\n\n

None.<\/p>\n","protected":false},"excerpt":{"rendered":"

COVID-19-associated hyperinflammation and escalation of […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19266"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19266"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19266\/revisions"}],"predecessor-version":[{"id":19269,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19266\/revisions\/19269"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19266"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19266"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}