Abstract:

Objective To investigate the effects of Framingham stroke risk on the circulating inflammation and prognosis in coronavirus disease 2019 (COVID-19) patients. Methods This was a single-center retrospective study which enrolled 158 COVID-19 patients. According to Framingham score for 10-year stroke risk, all subjects were divided into low-risk group (10-year stroke risk <10%), medium-risk group (10%-20%) and high-risk group (>20%). The levels of serum inflammation biomarkers including CRP, IL-6 and procalcitonin (PCT) in all patients were collected once a week for four consecutive weeks. The prognosis was defined as death within 4 weeks, hospitalization at 4 weeks and recovery. The prognosis and inflammation biomarkers level at different time point among three groups were compared, and multivariate logistic regression analysis was used to determine the relationship between Framingham stroke risk and the prognosis at 4 weeks. Results There was no statistical difference in inflammation biomarkers level among three groups at the first week. The serum IL-6 and PCT levels at the second, third and fourth week were significantly different among three groups, and serum CRP level at the second, third week was also significantly different among three groups. The serum CRP and IL-6 levels gradually decreased after the second week in low-risk group, while the PCT level was relatively stable. The IL-6 and PCT levels began to increase obviously at the fourth week in high-risk group. Compared with the high-risk group, the low-risk group had a lower risk of death (OR 0.062, 95%CI 0.004-0.772, P =0.031), the low-risk group (OR 0.117, 95%CI 0.031-0.396, P =0.001) and medium-risk group (OR 0.108, 95%CI 0.025- 0.501, P =0.004) had a lower risk of hospitalization. The mediation effect model showed that the higher level of serum IL-6 can partly explain the relationship between Framingham stroke risk and the poor prognosis of COVID-19 patients (death: β decreased by 13.7%, OR 0.071, 95%CI 0.005-0.815; hospitalization: β decreased by 19.1%, OR 0.128, 95%CI 0.034-0.452). Conclusions Higher Framingham stroke risk increased circulatory inflammatory response and poor prognosis in COVID-19 patients.

Key words: COVID-19; Framingham stroke risk; Inflammatory response; Prognosis

摘要：

目的 探讨弗雷明汉卒中危险因素负荷对2019冠状病毒病（coronavirus disease 2019，COVID-19）患者 循环炎症反应及预后的影响。 方法 本研究为单中心回顾性研究，分析了158例就诊于武汉大学中南医院隔离病区的COVID-19患 者。根据弗雷明汉10年卒中风险评分，将所有受试者分为卒中低危组（风险＜10%）、中危组（风险 10%～20%）和高危组（风险＞20%）。收集患者住院后每周的血清炎症指标检查结果，包括CRP、IL-6 和降钙素原（procalcitonin，PCT），连续4周。预后指标定义为病程4周内死亡、病程4周时仍需住院治疗 和痊愈。比较3组间预后和不同时间点的炎症指标差异，采用多元Logistic回归分析弗雷明汉卒中风险 与COVID-19患者4周预后的关系。 结果 发病第1周内的炎症指标在3组之间无显著的差异，第2周、第3周和第4周血清I L-6和PCT 水平在3组间有显著差异，第2周和3周的血清CRP水平也有显著的差异。低危组患者的血清CRP 和IL-6自第2周开始逐渐降低，PCT水平相对平稳，而高危组患者的IL-6和PCT水平在第4周明显上 升。多元Logi sti c回归分析结果显示，与弗雷明汉卒中高危组相比，低危组的死亡风险降低（OR 0.062，95%CI 0.004～0.772，P =0.031），低危组（OR 0.117，95%CI 0.031～0.396，P =0.001）与中危组 （OR 0.108，95%CI 0.025～0.501，P =0.004）患者病程第4周仍需要住院治疗的风险也均降低。中介效 应模型分析显示当纳入第2周IL-6水平为协变量时，弗雷明汉卒中低危组与死亡和第4周仍需住院治 疗之间的回归系数显著下降（死亡：β下降13.7%，OR 0.071，95%CI 0.005～0.815；仍需治疗：β下降 19.1%，OR 0.128，95%CI 0.034～0.452）。 结论 与弗雷明汉卒中高风险相比，卒中低、中风险COVID-19患者的炎症反应水平较低，不良预后 的风险较低。

关键词: 2019冠状病毒病; 弗雷明汉10年卒中风险; 炎症反应; 预后