背景:2019年冠状病毒病(COVID-19)经常伴有静脉血栓栓塞(VTE),其机制可能与COVID-19患者的炎症和免疫状态异常有关。已经证明白细胞介素-6(IL-6),铁蛋白和乳酸脱氢酶(LDH)可能在COVID-19感染时VTE的发生中起重要作用。但它们是否可以作为COVID-19中VTE的预测因子仍不清楚。在这项研究中,我们进行了系统评价和荟萃分析,比较了VTE和非VTECOVID-19患者的IL-6,铁蛋白和LDH,以阐明VTE的预防和治疗.
方法:在PubMed,Embase,WebofScience,谷歌学者,中国国家知识基础设施(CNKI),万丰。将COVID-19患者分为VTE组和非VTE组。然后进行Meta分析,比较两组间IL-6、铁蛋白和LDH水平。
结果:我们最终纳入并分析了2019年1月至2022年10月的17篇文献。共有7035例COVID-19患者,加权平均年龄为60.01岁。男性占62.64%,重症监护病房(ICU)占61.34%。IL-6、铁蛋白和LDH的加权平均差值(WMD)为31.15(95%CI:9.82,52.49),257.02(95%CI:51.70,462.33)和41.79(95%CI:-19.38,102.96),分别。以上结果表明,与非VTE组相比,VTE组的IL-6和铁蛋白水平明显较高,但LDH相似。
结论:本系统综述和荟萃分析指出,IL-6和铁蛋白水平升高与VTE显著相关,因此可作为COVID-19患者VTE的生物学预测指标。然而,LDH水平与VTE之间未发现相关性.因此,密切监测IL-6和铁蛋白浓度的变化对于帮助临床人员快速识别COVID-19患者的血栓并发症具有重要价值,从而促进及时有效的管理。需要进一步研究细胞因子在COVID-19感染中VTE发生中的临床作用,更可靠的系统控制和介入试验。
BACKGROUND: Coronavirus disease 2019 (COVID-19) is frequntly accompanied by venous thromboembolism (VTE), and its mechanism may be related to the abnormal inflammation and immune status of COVID-19 patients. It has been proved that interleukin-6 (IL-6), ferritin and lactate dehydrogenase (LDH) may play an important role in the occurrence of VTE in COVID-19 infection. But whether they can server as predictors for VTE in COVID-19 is still unclear. In this study, we performed a systematic
review and meta-analysis to compare IL-6, ferritin and LDH in VTE and non-VTE COVID-19 patients in order to shed light on the prevention and treatment of VTE.
METHODS: Related literatures were searched in PubMed, Embase, Web of Science, Google Scholar, China National Knowledge Infrastructure (CNKI), WANGFANG. COVID-19 patients were divided into VTE group and non-VTE group. Meta-analysis was then conducted to compare levels of IL-6, ferritin and LDH between the two groups.
RESULTS: We finally included and analyzed 17 literatures from January 2019 to October 2022. There was a total of 7,035 COVID-19 patients, with a weighted mean age of 60.01 years. Males accounted for 62.64% and 61.34% patients were in intensive care unit (ICU). Weighted mean difference (WMD) of IL-6, ferritin and LDH was 31.15 (95% CI: 9.82, 52.49), 257.02 (95% CI: 51.70, 462.33) and 41.79 (95% CI: -19.38, 102.96), respectively. The above results indicated that than compared with non-VTE group, VTE group had significantly higher levels of IL-6 and ferritin but similar LDH.
CONCLUSIONS: This systematic
review and meta-analysis pointed out that elevated levels of IL-6 and ferritin were significantly possitive associated with VTE, thus could be used as biological predictive indicators of VTE among COVID-19 patients. However, no association was found between level of LDH and VTE. Therefore, close monitoring of changes in IL-6 and ferritin concentrations is of great value in assisting clinicans to rapidly identify thrombotic complications among COVID-19 patients, hence facilitating the timely effective managment. Further studies are required in terms of the clinical role of cytokines in the occurrence of VTE among COVID-19 infection, with more reliable systematic controls and interventional trials.