NEU与LDH联合MEWS对新型冠状病毒感染合并血流感染预后的预测价值

Predictive value of neutrophil and lactate dehydrogenase combined with modified early warning score for prognosis of COVID-19 patients complicated by bloodstream infection

    摘要
  • 摘要:
    目的 探讨中性粒细胞(NEU)、乳酸脱氢酶(LDH)联合改良早期预警评分(MEWS)单独及联合检测对新型冠状病毒感染(COVID-19)合并血流感染(BSI)患者预后的预测价值，明确三者联合检测是否能提升预测效能。
    方法 选择2022年12月1日-2024年12月31日于徐州医科大学附属医院住院的188例COVID-19合并BSI患者，分为预后良好组和预后不良组。收集一般资料、计算MEWS、血液学指标、影像学结果等临床资料进行比较分析。
    结果 单因素logistic回归分析示，与COVID-19合并BSI患者预后相关的有年龄、基础疾病≥3种、深静脉置管、肠外营养(PN)、MEWS评分、NEU、C-反应蛋白(CRP)、降钙素原(PCT)、LDH、白细胞介素(IL)-8、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、胸腔积液、肺实变(P < 0.05)；多因素logistic回归分析示年龄、PN、NEU、LDH、MEWS是COVID-19合并BSI患者预后的独立危险因素(P < 0.05)。受试者工作特征(ROC)曲线分析：年龄、PN、NEU、LDH、MEWS评分预测COVID-19合并BSI患者预后的曲线下面积分别为0.684、0.842、0.788、0.731、0.913。当NEU、LDH、MEWS评分三者联合时，可获得更显著的预测效能(AUC＝0.958)。
    结论 年龄、PN、NEU、LDH、MEWS是影响COVID-19合并BSI患者预后的独立危险因素。NEU、LDH、MEWS三者联合对COVID-19合并BSI患者预后的预测价值最高。

     

    Abstract:
    OBJECTIVE To investigate the predictive value of neutrophil (NEU), lactate dehydrogenase (LDH) and modified early warning score (MEWS) alone and in combination for the prognosis of patients with COVID-19 complicated by bloodstream infection (BSI), and to determine whether the combined detection of these three factors can enhance the predictive efficacy.
    METHODS Atotal of 188 COVID-19 patients complicated by BSI who were hospitalized at the Affiliated Hospital of Xuzhou Medical University from Dec. 1, 2022, to Dec. 31, 2024, were enrolled and divided into a good prognosis group and a poor prognosis group. General information, MEWS calculation, hematological indicators, imaging results and other clinical data were collected and comparatively analyzed.
    RESULTS Univariate logistic regression analysis showed that factors associated with the prognosis of COVID-19 patients complicated by BSI included age, ≥3 comorbidities, deep vein catheterization, parenteral nutrition (PN), MEWS, NEU, C-reactive protein (CRP), procalcitonin (PCT), LDH, interleukin (IL)-8, activated partial thromboplastin time (APTT), prothrombin time (PT), aspartate aminotransferase (AST), albumin (ALB), pleural effusion and pulmonary consolidation (P < 0.05). Multivariate logistic regression analysis indicated that age, PN, NEU, LDH and MEWS were independent risk factors for the prognosis of COVID-19 patients complicated by BSI (P < 0.05). Receiver operating characteristic (ROC) curve analysis revealed that the areas under the curve (AUC) for predicting the prognosis of COVID-19 patients complicated by BSI by age, PN, NEU, LDH and MEWS were 0.684, 0.842, 0.788, 0.731 and 0.913, respectively. When NEU, LDH and MEWS were combined, a more significant predictive efficacy was achieved (AUC=0.958).
    CONCLUSIONS Age, PN, NEU, LDH and MEWS are independent risk factors affecting the prognosis of COVID-19 patients complicated by BSI. The combination of NEU, LDH and MEWS demonstrates the highest prognostic predictive value in COVID-19 patients complicated by BSI.

     

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