【原】【罂粟摘要】早期降钙素原预测危重COVID-19患者死亡率：一项多中心队列研究

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早期降钙素原预测危重COVID-19患者死亡率：一项多中心队列研究

贵州医科大学麻醉与心脏电生理课题组

翻译：陈锐  编辑：马艳燕  审校：曹莹

罂粟摘要

背景

 高水平的降钙素原(PCT)与COVID-19患者较高的死亡风险相关。我们探讨了早期评估PCT在危重COVID-19患者中的预后作用，以及PCT预测性能是否会受到免疫抑制的影响。

方法

对2020年3月至2020年6月在西班牙和安道尔所有入住36个重症监护病房(ICU)的COVID-19患者的前瞻性收集数据进行回顾性多中心分析。纳入确诊COVID-19和可用PCT值的成人（>18岁）患者（从ICU入院后<72小时）。患者被认为是“无免疫抑制”（NI）、“慢性免疫抑制”（CI）和“急性免疫抑制”（如果仅使用托珠单抗则为AIT组；如果仅使用类固醇则为AIS组，如果两者都使用则为AITS）。主要观察指标是PCT预测ICU死亡率的效能。

结果

在1079名符合纳入条件的患者中，分析777名患者数据。227名(28%)患者死亡。NI组144例（19%），CI组67例（9%），AIT组66例（8%），AIS组262例（34%）和，AITS组238例（31%）；与存活的患者的相比，死亡患者的PCT显著升高（0.64[0.17-1.44]vs.0.23[0.11-0.60]ng/mL；p<0.01）；然而，在多变量分析中，PCT值与ICU死亡率并不独立相关。NI和CI组患者的PCT值和ICU死亡率显著升高。

结论

 PCT值不是COVID-19患者ICU死亡率的独立预测因子。急性免疫抑制显著降低PCT值，但不影响其预测值。

原始文献来源：Luigi Zattera , Ioannis Veliziotis , Adela Benitez-Cano,et.al Minerva Anestesiologica 2022 Jan 24 DOI: 10.23736/S0375-9393.22.15942-0.

英文原文

Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study

Background: High levels of procalcitonin (PCT) have been associated with a higher risk of mortality in COVID-19 patients. We explored the prognostic role of early PCT assessment in critically ill COVID-19 patients and whether PCT predictive performance would be influenced by immunosuppression.

Methods: Retrospective multicentric analysis of prospective collected data in COVID-19 patients consecutively admitted to 36 intensive care units (ICUs) in Spain and Andorra from March to June 2020. Adult (>18 years) patients with confirmed COVID-19 and available PCT values (<72 hours from ICU admission) were included. Patients were considered as "No Immunosuppression" (NI), "Chronic Immunosuppression" (CI) and "Acute Immunosuppression" (AIT if only tocilizumab; AIS if only steroids, AITS if both). The primary outcome was the ability of PCT to predict ICU mortality.

Results: Of the 1079 eligible patients, 777 patients were included in the analysis. Mortality occurred in 227 (28%) patients. In the NI group 144 (19%) patients were included, 67 (9%) in the CI group, 66 (8%) in the AIT group, 262 (34%) in the AIS group and 238 (31%) in the AITS group; PCT was significantly higher in non-survivors when compared with survivors (0.64 [0.17-1.44] vs. 0.23 [0.11-0.60] ng/mL; p<0.01); however, in the multivariable analysis, PCT values was not independently associated with ICU mortality. PCT values and ICU mortality were significantly higher in patients in the NI and CI groups.

Conclusions: PCT values are not independent predictors of ICU mortality in COVID-19 patients. Acute immunosuppression significantly reduced PCT values, although not influencing its predictive value.

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