ABSTRACT
Background Systemic inflammation is closely related to the progress of COVID-19.This study aimed to explore the role of combined detection of heparin-binding protein (HBP), interleukin-6 (IL6), and C-reactive protein (CRP) on the severity and clinical outcomes of COVID-19. Methods Our hospital conducted a retrospective analysis of 214 patients with COVID-19 from 1 December 2022 to 28 February 2023. Patients were separated into non-severe and severe categories. Based on whether there was organ failure during hospitalization, patients were further split into the non-organ failure group and the organ failure group. Records on demographics, baseline, and clinical features, as well as the levels of HBP, IL6, and CRP on admission, were collected. Results HBP, IL6, and CRP levels were positively correlated with total bilirubin, lactate dehydrogenase, serum creatinine, and D-dimer but negatively correlated with albumin. HBP, IL6, and CRP levels were remarkably higher in severe, organ failure, and non-survivor groups compared to non-severe, non-organ failure, and survivor groups (all P < 0.001). The optimal cutoff values of HBP, IL6, and CRP for predicting severe COVID-19 were 49.71 ng/mL, 11.24 pg/mL, and 39.67 mg/L, respectively. With a sensitivity and specificity of 85.10% and 95.70% for severe COVID-19, the combined detection of HBP, IL6, and CRP showed the best diagnostic effectiveness. Logistic regression revealed that HBP, IL6, and CRP were independent risk factors for severe COVID-19 and organ failure. Moreover, the risk of death predicted by any two or more of HBP, IL6, and CRP higher than the optimal cutoff value was 3.631 times that of only one of the three indicators higher than the optimal cutoff value (hazard ratio = 3.631, log-rank P = 0.003). Conclusions A combination of HBP, IL6, and CRP has higher diagnostic efficiency of severe COVID-19; combined detection can more accurately and efficiently predict COVID-19 severity, organ failure, and prognosis, which is complementary to previous studies.
Subject(s)
Multiple Organ Failure , Death , COVID-19 , InflammationABSTRACT
Objective: To explore the clinical value of admission blood glucose level on prognosis of COVID- 19 patients. Methods A total of 420 novel coronavirus pneumonia (COVID-19) patients admitted to Tongji Hospital of Tongji MedicalCollege from January 18, 2020 to February 26, 2020 were selected as the subjects of study. The data of diabetes or not, admissionblood glucose level(GLU), clinical severity grade were collected through the electronic medical record system, and the outcome, which defined as in-hospital motality, was also monitored. The patients were divided into diabetes group and non-diabetes groupin terms of the complication of diabetes, and then, firstly, stratified these two groups into survival subgroup and non-survivalsubgroup in according to the event of in-hospital motality, GLU between these two subgroups were compared. Secondly, according to the clinical severity grade, these two groups were stratified into moderate subgroup, severe subgroup and criticalsubgroup, and GLU among these subgroups were also compared. Thirdly, according to the admission blood glucose level, stratified these two groups into GLU 3.9~7.8 mmol /L subgroup, GLU 7.8~10.0 mmol/L subgroup and GLU>10.0 mmol/Lsubgroup, the in-hospital motality rates among these subgroups were compared. Finally, the multivariate logistic regression wasused to explore whether increased GLU were independent risk factor for in-hospital motality in diabetes group and non-diabetesgroup when adjusted for sex, age and underlying disease. Results In non-diabetes group, compared with Survival subgroup, GLUwas significantly elevated in non-Survival subgroup[6.96(5.95, 8.23)mmol/L vs 5.96 (5.32, 6.92) mmol/L], the difference wasstatistically significant(U=6047.0, P < 0.001), but in diabetes group, there was no significant difference between non-survivalsubgroup and Survival subgroup [12.42(8.41, 18.17) mmol/L vs 9.88 (7.79, 14.02) mmol/L], the difference was statisticallysignificant(U=1 200.5, P=0.059).In Non-diabetes group, GLU elevated remarkably along with the clinical severity gradeincreased, moderate subgroup, severe subgroup, critical subgroup GLU were 5.87(5.24, 6.69) mmol/L, 6.94(5.95, 7.90) mmol/L,9.73 (6.22, 11.64) mmol/L, the difference were statistically significant, respectively(U=723.0~4978.0, all P < 0.01). However indiabetes group, there was no significant difference on GLU when the clinical severity grade increased, moderate subgroup, severesubgroup, critical subgroup GLU were 9.88(7.81, 11.93)mmol/L, 12.42(8.43, 16.94)mmol/L, 11.43(7.89, 18.76)mmol/L, the difference were statistically significant, respectively (U=262.0~946.5, all P>0.05).In non-diabetes group, GLU> 10.0 mmol/L subgroup had the hightest in-hospital motality rate (72.0%) among all three subgroups, the differences were statisticallysignificant(X2=24.607, 9.625, all P < 0.01), when compared between GLU 3.9~7.8 mmol/L subgroup (in-hospital motality rate24.8%) and GLU 7.8~10.0 mmol/L subgroup (in-hospital motality rate 30.0%), there was no significant difference on in-hospitalmotality rate (X2=0.383, P > 0.05). However, in diabetes group, along with GLU increased, it had no significant difference on inhospitalmotality rate, GLU 3.9~7.8 mmol/L subgroup, GLU 7.8~10.0 mmol/L subgroup, GLU> 10.0 mmol/L subgroup, the inhospitalmotality rate were 34.8%, 41.4%, 49.2%, respectively(X2=0.236~1.380, all P> 0.05). Multivariate logistic regressionshowed, in non-diabets group, GLU>10.0 mmol/L was the independent risk factor when adjusted for sex, age and underlyingdisease, odds ratio was 7.969, and 95% confidence interval was 3.022~21.013, but in diabets group.It seemed that GLU>10.0 mmol/L was not the independent risk factor. Conclusion Admission blood glucose is a good predictor for disease severity andoutcome in non-diabetes patients with COVID-19. When admission hyperglycemia occurs, it tends to predict a poor prognosis.