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Clinical Characteristics and Inflammatory Markers of Omicron BA.5.2 Variant Infection in Hospitalized Patients and Their Predictive Role in Disease Prognosis
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摘要: 目的 分析 Omicron BA.5.2 变异株感染住院患者临床特征及炎症指标,筛选可能的预后诊断标志物。 方法 回顾性收集 2022 年 8 月 1 日-11 月 30日新疆维吾尔自治区人民医院收治的 Omicron BA.5.2 变异株感染住院患者临床资料,根据疾病严重程度将患者分为轻型、普通型、重型和危重型,比较 4 组临床资料差异, 采用二元 Logistic 回归法分析与疾病严重程度相关的炎症指标,采用多因素 Logistic 回归法分析各指标与疾病预后的相关性,采用受试者工作特征(receiver operator characteristic, ROC) 曲线分析各指标对疾病严重程度和预后的诊断价值。 结果 共纳入符合纳入和排除标准的 3006 例患者,其中男性 1522 例(50.63%)、女性 1484 例(49.37%); 平均年龄为(58.72±18.01) (14~96)岁;根据疾病严重程度分为轻型(40.98%, 1232/3006)、普通型(52.56%,1580/3006)、重型(4.26%, 128/3006)、危重型(2.20%, 66/3006);各组在合并基础疾病(心脏病、糖尿病、高血压、肾脏病、肺部疾病、恶性肿瘤、脑部疾病、病毒性肝炎和自身免疫性疾病) 方面比较均具有显著性差异(P 均<0.01);住院期间共死亡 74 例(2.43%),其中危重型 46 例(63.01%)、重型 19 例(26.03%)、普通型 7 例(9.60%)、轻型 2 例(2.74%),年龄 ≥ 70 岁的死亡患者占比为 75.68%(56/74),所有死亡患者均为合并基础疾病人群; C-反应蛋白(C-reactive protein,CRP)、白蛋白水平是疾病严重程度的独立危险因素,且 CRP 与疾病严重程度呈显著正相关(P=0.002), 白蛋白水平与疾病严重程度呈显著负相关(P<0.001);CRP、全身炎症反应指数(systemic inflammatory response index, SIRI)、全身免疫炎症指数 (systemic immune-inflammation index, SII) 为疾病预后的独立危险因素,且 CRP、SIRI 与疾病预后呈显著正相关(P=0.027, P=0.025), SII 与疾病预后呈显著负相关(P=0.021); CRP、白细胞介素-6(interleukin-6, IL-6)、D-二聚体、中性粒细胞与淋巴细胞比率(neutrophil-lymphocyte ratio, NLR) 对应的曲线下面积(area under the curve, AUC) 均>0.70, 对疾病严重程度分型的诊断价值较高; CRP、IL-6、降钙素原(procalcitonin, PCT)、D-二聚体、肌钙蛋白 T(troponin T, TnT)、TnI、NLR、SII、血小板与淋巴细胞比值(platelet tolymphocyte ratio, PLR)、单核细胞与淋巴细胞比值(monocyte-lymphocyte ratio,MLR) 对应的 AUC 均>0.70, 对死亡或存活的预后诊断价值较高。 结论 不同疾病严重程度的 Omicron BA.5.2 变异株感染住院患者临床特征比较具有显著差异,结合 CRP、IL-6、PCT、D-二聚体、TnT、TnI、NLR、SII、PLR、MLR 的预测模型可早期识别 Omicron BA.5.2 变异株感染住院患者中的高危人群, 及时进行早期诊断和治疗。
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关键词:
- 新型冠状病毒肺炎 /
- Omicron BA.5.2 /
- 炎症指标 /
- 临床特征 /
- 预后
Abstract: Objective To analyze the clinical characteristics and inflammatory indicators of hospitalized patients infected with Omicron BA. 5.2 variant, and screen for possible prognostic diagnostic markers. Methods We retrospectively collected clinical data from hospitalized patients with Omicron BA. 5.2 variant infection admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from August 1 to November 30, 2022. The patients were divided into mild, common, severe, and critically ill patient groups based on the severity of the disease. The differences in clinical data between the four groups were compared, and binary logistic regression was used to analyze inflammation indicators related to the severity of the disease. Multiple logistic regression method and receiver operator characteristic (ROC) curve were used to analyze the correlation between various indicators and patient prognosis, as well as the evaluation value for disease severity and prognosis. Results A total of 3006 patients who met the inclusion and exclusion criteria were included, including 1522 males (50.63%) and 1484 females (49.37%), with an average age of (58.72 ±18.01) years. According to the severity of the disease, they were classified into mild (40.98%, 1232/3006), ordinary (52.56%, 1580/3006), severe (4.26%, 128/3006), and critically severe (2.20%, 66/3006) groups. There was a significant difference (P<0.01) in the merging of underlying diseases including cardiac disease, diabetes, hypertension, kidney disease, lung disease, malignant tumor, brain disease, viral hepatitis and autoimmune disease among each group. During the hospitalization period, a total of 74 cases (2.43%) died, including 46 cases of severe illness (63.01%), 19 cases of severe illness (26.03%), 7 cases of ordinary illness (9.60%), and 2 cases of mild illness (2.74%). The proportion of death patients aged ≥ 70 years old was 75.68%（56/74）, and all deaths were among those with underlying diseases. CRP and albumin levels were independent risk factors for disease severity, and C-reactive protein (CRP) was significantly positively correlated with disease severity (P=0.002), while albumin levels were significantly negatively correlated with disease severity (P<0.001). CRP, systemic inflammatory response index (SIRI), and systemic immune inflammation index (SII) were independent risk factors for disease prognosis, and CRP and SIRI were significantly positively correlated with disease prognosis (P=0.027, P=0.025), while SII was significantly negatively correlated with disease prognosis (P=0.021). CRP, interleukin-6 (IL-6), D-dimer, and neutrophil lymphocyte ratio (NLR) had high diagnostic value for disease severity classification, while CRP, IL-6, procalcitonin (PCT), D-dimer, troponin T (TnT), troponin I (TnI), neutrophil lymphocyte ratio (NLR), SII, platelet to lymphocyte ratio (PLR), the monocyte lymphocyte ratio (MLR) had a high prognostic diagnostic value for death or survival. Conclusion There were significant differences in clinical characteristics among hospitalized patients infected with Omicron BA. 5.2 variant strains with different disease severity. Combining CRP, IL-6, D-dimer, PCT, D-dimer, TnT, TnI, NLR, SII, PLR, and MLR prediction models may enable early identification of high-risk populations among hospitalized patients infected with Omicron BA. 5.2 variant strains, and provide timely diagnosis and treatment.-
Key words:
- corona virus disease 2019 /
- Omicron BA.5.2 /
- inflammation index /
- clinical characteristics /
- prognosis
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