Li Hongbing, Zhao Maojun, Xu Yingsheng
Department of Emergency Medicine, Guiyang First People's Hospital, Guiyang 550002, China.
Department of Nutrition, Ezhou Central Hospital, Ezhou 436000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Jul 30;40(7):965-971. doi: 10.12122/j.issn.1673-4254.2020.07.08.
To identify the key biochemical indicators that affect the clinical type and outcomes of COVID-19 patients and explore the application of neutrophil/lymphocyte ratio (NLR) in COVID-19.
Ninety-three patients with confirmed diagnosis of COVID-19 admitted in Ezhou Central Hospital from February to April in 2020 were analyzed. Among them, 43 patients were selected from Intensive Care Unit (ICU) with the diagnosis of critical type of COVID-19, and 50 cases of common type were selected from the Department of Respiratory Medicine. The baseline data, blood routine test and biochemical indexes of the patients were collected on the first day of admission. NLRs of the patients were calculated, and COX survival analysis according to the NLR 4-category method was performed. The patients' outcomes were analyzed with receiver operating curves (ROCs). The patients were divided into two groups according to NLR cutoff value for comparison of the biochemical indexes. Based on the patients' outcomes, NLR cutoff value classification and clinical classification, multiple binary logistics regression was performed to screen the key variables and explore their significance in COVID-19.
The NLR four-category method was not applicable for prognostic evaluation of the patients. The cut-off value of NLR for predict the prognosis of COVID-19 was 11.26, with a sensitivity of 0.903 and a specificity of 0.839; the laboratory indicators of the patients with NLR < 11.26 were similar to those in patients of the common type; the indicators were also similar between patients with NLR≥11.26 and those with critical type COVID-19. NLR, WBC, NEUT, PCT, DD, BUN, TNI, BNP, and LDH had significant effects on the clinical classification and outcome of the patients ( < 0.05); Cr, Ca, PH, and Lac had greater impact on the outcome of the patients ( < 0.05), while Na, PCO had greater impact on the clinical classification of the patients ( < 0.05).
NLR can be used as an important reference for clinical classification, prognostic assessment, and biochemical abnormalities of COVID-19. Patients of critical type more frequently have bacterial infection with more serious inflammatory reactions, severer heart, lung and kidney damages, and much higher levels of DD and LDH than those of the common type. NLR, NEUT, DD, TNI, BNP, LDH, Ca, PCT, PH, and Lac have obvious influence on the prognosis of COVID-19 and should be observed dynamically.
确定影响新型冠状病毒肺炎（COVID-19）患者临床类型及预后的关键生化指标，探讨中性粒细胞/淋巴细胞比值（NLR）在COVID-19中的应用。
分析2020年2月至4月在鄂州市中心医院收治的93例确诊COVID-19患者。其中，从重症监护病房（ICU）选取43例诊断为危重型COVID-19的患者，从呼吸内科选取50例普通型患者。收集患者入院首日的基线资料、血常规及生化指标。计算患者的NLR，采用NLR四分法进行COX生存分析。用受试者工作特征曲线（ROC）分析患者的预后情况。根据NLR临界值将患者分为两组，比较生化指标。基于患者的预后、NLR临界值分类及临床分类，进行多因素二元logistic回归分析，筛选关键变量并探讨其在COVID-19中的意义。
NLR四分法不适用于该患者群体的预后评估。预测COVID-19预后的NLR临界值为11.26，灵敏度为0.903，特异度为0.839；NLR＜11.26患者的实验室指标与普通型患者相似；NLR≥11.26患者与危重型COVID-19患者的指标也相似。NLR、白细胞（WBC）、中性粒细胞（NEUT）、降钙素原（PCT）、D-二聚体（DD）、尿素氮（BUN）、肌钙蛋白I（TNI）、脑钠肽（BNP）及乳酸脱氢酶（LDH）对患者的临床分类及预后有显著影响（P＜0.05）；肌酐（Cr）、钙（Ca）、酸碱度（PH）及乳酸（Lac）对患者预后影响较大（P＜0.05），而钠（Na）、二氧化碳分压（PCO）对患者临床分类影响较大（P＜0.05）。
NLR可作为COVID-19临床分类、预后评估及生化异常的重要参考指标。危重型患者较普通型患者更易合并细菌感染，炎症反应更严重，心、肺、肾损害更严重，DD及LDH水平更高。NLR、NEUT、DD、TNI、BNP、LDH、Ca、PCT、PH及Lac对COVID-19预后有明显影响，应动态观察。
