Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

作     者：Harinivaas Shanmugavel Geetha Sushmita Prabhu Abinesh Sekar Maya Gogtay Yuvaraj Singh Ajay K Mishra George M Abraham Suzanne Martin 

作者机构：Department of Internal MedicineSaint Vincent HospitalWorcesterMA 01608United States Hospice and Palliative MedicineUniversity of Texas Health-San AntonioSan AntonioTX 78201United States Division of CardiologySaint Vincent HospitalWorcesterMA 01608United States Department of NephrologySaint Vincent HospitalWorcesterMA 01608United States 

出 版 物：《World Journal of Virology》 (世界病毒学杂志)

年 卷 期：2023年第12卷第5期

页      面：286-295页

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Coronavirus disease 2019 Chronic kidney disease Inflammatory markers C-reactive protein Invasive mechanical ventilation Non-invasive mechanical ventilation 

摘      要：BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.