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The following article is from Gastroenterology, by Hong-Yu Chu, et al.
Gastroenterology
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Text: Chu Hongyu, Zhou Lu, Guo Liping, Wang Bangmao
Affiliation: Tianjin Medical University General Hospital
Early identification of novel coronavirus pneumonia (NCP) is the focus of clinical work during an outbreak. In addition to the virus nucleic acid test, which is a specific test, serological indicators have important reference value in the early identification of NCP. Its serological indicators can be manifested as leukopenia, decreased absolute value of lymphocytes, abnormal liver function, coagulation function, etc [1].
Based on this, this review summarizes the changes of serological indicators related to NCP patients, so as to achieve early detection, early diagnosis, early management and early treatment of infections, improve patient survival, prevent infectious diseases, and provide help for clinical work during epidemics.
Characteristics of serologic indicators in patients with NCP
Dawei Wang et al [2] analyzed the clinical data of 138 NCP patients in Wuhan and found that.
The most common laboratory test abnormalities were decreased lymphocyte count, prolonged prothrombin time and elevated lactate dehydrogenase (LDH). clinical data from five deceased patients showed persistently elevated neutrophil count, D-dimer, serum urea nitrogen and creatinine levels, and persistently decreased lymphocyte count.
Yingxia Liu et al [3] retrospectively analyzed the clinical data of 12 patients with NCP in Wuhan and found that.
The most common abnormal serological indicators were hypoalbuminemia, decreased lymphocyte count, decreased lymphocyte and neutrophil percentages, elevated C-reaction protein (CRP) and lactate dehydrogenase, and decreased CD8+ T cell subpopulation counts.
Nanshan Chen et al [4] analyzed the clinical data of 99 patients with NCP in Wuhan and found that.
9 (9%) patients had lower than normal total leukocyte count, 24 (24%) patients had higher than normal total leukocyte count, 38 (38%) patients had higher than normal neutrophils, 35 (35%) patients had lower than normal lymphocytes and 51 (51%) patients had lower than normal hemoglobin, 12 (12%) patients had lower than normal platelets, and 43 (43%) patients had different abnormal liver function in 43 (43%) patients.
Ning Tang et al [5] retrospectively analyzed the coagulation indexes of 183 patients with NCP diagnosed in Tongji Hospital and found that.
Significantly elevated D -dimers and fibrin degradation products (FDP) were common causes of death in NCP. The characteristics of serological indicators of NCP are summarized below (Table 1).
◆ Routine blood tests.
Patients with NCP have normal or reduced total leukocyte count, reduced lymphocyte count, some with increased proportion of monocytes, and some patients may also have thrombocytopenia. The CD4+ and CD8+ T lymphocyte subsets are reduced, and the reduction of CD4+ T cells is more obvious. The absolute values of white blood cell count and lymphocytes were mostly normal in children.
◆ Inflammatory indicators.
CRP is elevated, erythrocyte sedimentation rate (ESR) is increased, procalcitonin (PCT) is normal, and PCT is increased when combined with bacterial infection. If CRP and serum ferritin are significantly increased, it indicates aggravation or deterioration of the disease.
◆ Blood biochemical examination.
Some critically ill patients with organ failure may have creatine kinase (CK), LDH, aspartate aminotransferase (AST), troponin, alanine aminotransferase (ALT) ◆ Coagulation function: The coagulation function of the blood should be increased, and the serum urea nitrogen and creatinine should be increased, and the albumin (ALB) should be decreased.
◆ Coagulation function.
Most patients have normal coagulation function, but severe patients may have coagulation disorder, and more patients have elevated D-dimer and fibrinogen (FIB).
◆ Blood gas analysis.
Arterial oxygen saturation and partial pressure of oxygen may be decreased and partial pressure of carbon dioxide may be increased in critically ill patients, and PH may be decreased in those with combined metabolic acidosis.
Table 1. Characteristics of NCP serological indicators
[Reference
[1] Treatment protocol for pneumonia in novel coronavirus infection (trial version 6)
[2] Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. jama . 2020 .
[3] Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020 .
[4] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a Lancet. 2020. 395(10223): 507-513.
[5] Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. j Thromb Haemost. 2020 .
