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Abstract：
During the initial diagnosis of urgent medical conditions, which include acute infectious diseases, it is important to assess the severity of the patient\'s clinical state as quickly as possible. Unlike individual biochemical or physiological indicators, derived indices make it possible to better characterize a complex syndrome as a set of symptoms, and therefore quickly take a set of adequate measures. Recently, we reported on novel diagnostic indices containing butyrylcholinesterase (BChE) activity, which is decreased in COVID-19 patients. Also, in these patients, the secretion of von Willebrand factor (vWF) increases, which leads to thrombosis in the microvascular bed. The objective of this study was the determination of the concentration and activity of vWF in patients with COVID-19, and the search for new diagnostic indices. One of the main objectives was to compare the prognostic values of some individual and newly derived indices. Patients with COVID-19 were retrospectively divided into two groups: survivors (n = 77) and deceased (n = 24). According to clinical symptoms and computed tomography (CT) results, the course of disease was predominantly moderate in severity. The first blood sample (first point) was taken upon admission to the hospital, the second sample (second point)-within 4-6 days after admission. Along with the standard spectrum of biochemical indicators, BChE activity (BChEa or BChEb for acetylthiocholin or butyrylthiocholin, respectively), malondialdehyde (MDA), and vWF analysis (its antigen level, AGFW, and its activity, ActWF) were determined and new diagnostic indices were derived. The pooled sensitivity, specificity, and area under the receiver operating curve (AUC), as well as Likelihood ratio (LR) and Odds ratio (OR) were calculated. The level of vWF antigen in the deceased group was 1.5-fold higher than the level in the group of survivors. Indices that include vWF antigen levels are superior to indices using vWF activity. It was found that the index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) had the best discriminatory power to predict COVID-19 mortality (AUC = 0.91 [0.83, 1.00], p < 0.0001; OR = 72.0 [7.5, 689], p = 0.0002). In addition, [Urea] × 1000/(BChEb × [ALB]) was a good predictor of mortality (AUC = 0.95 [0.89, 1.00], p < 0.0001; OR = 31.5 [3.4, 293], p = 0.0024). The index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) was the best predictor of mortality associated with COVID-19 infection, followed by [Urea] × 1000/(BChEb × [ALB]). After validation in a subsequent cohort, these two indices could be recommended for diagnostic laboratories.
摘要：
在紧急医疗状况的初步诊断期间，其中包括急性传染病，尽快评估患者临床状态的严重程度非常重要。与个体生化或生理指标不同，推导出的指数可以更好地将复杂综合征描述为一组症状，因此迅速采取了一套适当的措施。最近,我们报道了含有丁酰胆碱酯酶（BChE）活性的新型诊断指标，在COVID-19患者中下降。此外，在这些患者中，血管性血友病因子(vWF)的分泌增加，导致微血管床上的血栓形成。这项研究的目的是确定COVID-19患者vWF的浓度和活性，并寻找新的诊断指标。主要目标之一是比较某些个体和新得出的指标的预后值。回顾性地将COVID-19患者分为两组：幸存者（n=77）和死亡（n=24）。根据临床症状和计算机断层扫描（CT）结果，病程以中度为主.入院时采集了第一份血样(第一点),第二个样本（第二点）-入院后4-6天内。随着生化指标的标准光谱，BChE活性（BChEa或BChEb用于乙酰硫代胆碱或丁酰硫代胆碱，分别)，丙二醛（MDA），和vWF分析(其抗原水平，AGFW,和它的活动，确定ActWF）并得出新的诊断指标。汇集的敏感性，特异性，和接收器工作曲线下面积（AUC），计算似然比(LR)和赔率比(OR)。死亡组的vWF抗原水平比幸存者组高1.5倍。包括vWF抗原水平的指标优于使用vWF活性的指标。发现指数[Urea]×[AGWF]×1000/(BChEb×[ALB])预测COVID-19死亡率的判别力最好(AUC=0.91[0.83,1.00],p<0.0001；OR=72.0[7.5,689]，p=0.0002)。此外,[尿素]×1000/(BChEb×[ALB])是死亡率的良好预测因子(AUC=0.95[0.89,1.00],p<0.0001；OR=31.5[3.4,293]，p=0.0024)。[尿素]×[AGWF]×1000/（BChEb×[ALB]）指数是COVID-19感染相关死亡率的最佳预测指标，其次是[尿素]×1000/(BChEb×[ALB])。在后续队列中验证后，这两个指数可以推荐给诊断实验室。
