背景:钙卫蛋白(S100A8/A9)是主要从嗜中性粒细胞释放的促炎介质。以前的研究揭示了血浆钙卫蛋白之间的关联,未选择的COVID-19患者的疾病严重程度和院内死亡率。
目的:我们旨在评估重症监护第一周血浆钙卫蛋白动力学是否与重症COVID-19患者的死亡率和功能结局相关。
方法:这项前瞻性研究包括2020年5月至2021年5月在瑞典6个重症监护病房(ICU)收治的498名COVID-19患者。在ICU入院时和第7天收集血液样品。主要结果是12个月死亡率。次要结果是幸存者在3个月和12个月时的功能结果,以及ICU住院期间需要有创机械通气(IMV)或连续性肾脏替代治疗(CRRT)。通过格拉斯哥结果量表扩展(GOSE,范围1-8,<5代表不利结果)。血浆钙卫蛋白与结果之间的关联在调整年龄的二元逻辑回归分析中进行了检查,性别,BMI,高血压,吸烟,和肌酐。
结果:入院时和第7天高血浆钙卫蛋白与12个月死亡率增加独立相关。从入院到第7天增加钙卫蛋白与12个月时更高的死亡率独立相关[OR2.10(95%CI1.18-3.74),p=0.012],3个月时不利的功能结局[OR2.53(95%CI1.07-6.10),p=0.036],和IMV的使用[OR2.23(95%CI1.10-4.53),p=0.027)]和CRRT[OR2.07(95%CI1.07-4.00),p=0.031)]。包括第7天钙卫蛋白和年龄的受试者操作员特征(ROC)模型是12个月死亡率的良好预测指标[AUC0.79(95%CI0.74-0.84),p<0.001]。第7天钙卫蛋白单独预测3个月时不利的功能结果[AUC0.67(95%CI0.58-0.76),p<0.001]。
结论:在重症COVID-19患者中,入住ICU后钙卫蛋白水平升高与幸存者12个月死亡率和不利的功能结局相关.在ICU中监测血浆钙卫蛋白动力学可能被认为是评估危重COVID-19的预后。
背景:ClinicalTrials.gov标识符:NCT04974775,注册于2020年4月28日。
BACKGROUND: Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma
calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.
OBJECTIVE: We aimed to assess whether plasma
calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.
METHODS: This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.
RESULTS: High plasma
calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing
calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001].
CONCLUSIONS: In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.