Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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1er cuartil (5 de 32)
Emergency Medicine
Resumen
< ReturnProcalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level
López-Ayala P, Alcaraz-Serna A, Valls Carbó A, Cuadrado Cenzual MA, Torrejón MartÃnez MJ, López Picado A, MartÃnez Valero C, Miranda JD, DÃaz del Arco C, Cozar López G, Suárez-Cadenas MM, Jerez Fernández P, Angós B, RodrÃguez Adrada E, Cardassay E, Del Toro E, Chaparro D, Montalvo Moraleda MT, Espejo Paeres C, GarcÃa Briñón MA, Hernández MartÃn-Romo V, Ortega L, Fernández Pérez C, MartÃnez-Novillo M, González Armengol JJ, González Del Castillo J, Mueller CE, MartÃn-Sánchez FJ
Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de CardiologÃa, Hospital Universitario de Basel, Universidad de Basel, Basel, Switzerland. Hospital Universitario de Lausanne (CHUV), Departamento de Medicine, Servicio de InmunologÃa y AlergologÃa, Lausanne, Switzerland. Servicio de NeurologÃa, Hospital ClÃnico San Carlos, Madrid, Spain. Servicio de Laboratorio de Análisis Biomédicos, Hospital ClÃnico San Carlos, Madrid, Spain. Facultad de Medicina, Universidad Complutense de Madrid, Spain. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, Spain. División de Modelos de Riesgo de Repsol, Madrid, Spain. Servicio de AnatomÃa Patológica, Hospital ClÃnico San Carlos, Madrid, Spain. Servicio de Urgencias, Hospital ClÃnico San Carlos, Madrid, Spain. Servicio de CardiologÃa, Hospital ClÃnico San Carlos, Madrid, Spain. Departamento de Sistemas de la Información y TecnologÃas, Hospital ClÃnico San Carlos, Madrid, Spain. Servicio de Medicina Preventiva, Hospital ClÃnico San Carlos, Madrid, Spain.
Background. Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers.
Methods. Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose–response curves.
Results. We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P < .001). The areas under the
receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P < .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P < .001). The proposed PCT concentration decision
points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality.
Conclusion. PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.
Methods. Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose–response curves.
Results. We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P < .001). The areas under the
receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P < .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P < .001). The proposed PCT concentration decision
points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality.
Conclusion. PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.
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