Man Milena Adina, Rajnoveanu Ruxandra-Mioara, Motoc Nicoleta Stefania, Bondor Cosmina Ioana, Chis Ana Florica, Lesan Andrei, Puiu Ruxandra, Lucaciu Sergiu-Remus, Dantes Elena, Gergely-Domokos Bianca, Fira-Mladinescu Ovidiu
Department of Medical Sciences, Pulmonology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Cluj, Romania.
"Leon Daniello," Clinical Hospital of Pulmonology, Cluj Napoca, Cluj, Romania.
PLoS One. 2021 Jun 28;16(6):e0252599. doi: 10.1371/journal.pone.0252599. eCollection 2021.
Inflammation has an important role in the progression of various viral pneumonia, including COVID-19. Circulating biomarkers that can evaluate inflammation and immune status are potentially useful in diagnosing and prognosis of COVID-19 patients. Even more so when they are a part of the routine evaluation, chest CT could have even higher diagnostic accuracy than RT-PCT alone in a suggestive clinical context. This study aims to evaluate the correlation between inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocytes ratio (PLR), and eosinophils with the severity of CT lesions in patients with COVID-19. The second objective was to seek a statically significant cut-off value for NLR and PLR that could suggest COVID-19. Correlation of both NLR and PLR with already established inflammatory markers such as CRP, ESR, and those specific for COVID-19 (ferritin, D-dimers, and eosinophils) were also evaluated. One hundred forty-nine patients with confirmed COVID-19 disease and 149 age-matched control were evaluated through blood tests, and COVID-19 patients had thorax CT performed. Both NLR and PLR correlated positive chest CT scan severity. Both NLR and PLR correlated positive chest CT scan severity. When NLR value is below 5.04, CT score is lower than 3 with a probability of 94%, while when NLR is higher than 5.04, the probability of severe CT changes is only 50%. For eosinophils, a value of 0.35% corresponds to chest CT severity of 2 (Se = 0.88, Sp = 0.43, AUC = 0.661, 95% CI (0.544; 0.779), p = 0.021. NLR and PLR had significantly higher values in COVID-19 patients. In our study a NLR = 2.90 and PLR = 186 have a good specificity (0.89, p = 0.001, respectively 0.92, p<0.001). Higher levels in NLR, PLR should prompt the clinician to prescribe a thorax CT as it could reveal important lesions that could influence the patient's future management.
炎症在包括新型冠状病毒肺炎（COVID-19）在内的各种病毒性肺炎进展中发挥着重要作用。能够评估炎症和免疫状态的循环生物标志物在COVID-19患者的诊断和预后方面可能具有重要价值。在提示性临床背景下，胸部CT作为常规评估的一部分，其诊断准确性甚至可能高于单独的逆转录聚合酶链反应（RT-PCR）。本研究旨在评估中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和嗜酸性粒细胞等炎症标志物与COVID-19患者CT病变严重程度之间的相关性。第二个目标是寻找NLR和PLR的具有统计学意义的临界值，以提示COVID-19。还评估了NLR和PLR与已确定的炎症标志物如C反应蛋白（CRP）、红细胞沉降率（ESR）以及COVID-19特异性标志物（铁蛋白、D-二聚体和嗜酸性粒细胞）之间的相关性。对149例确诊COVID-19的患者和149例年龄匹配的对照者进行了血液检查，并对COVID-19患者进行了胸部CT检查。NLR和PLR均与胸部CT扫描严重程度呈正相关。当NLR值低于5.04时，CT评分低于3的概率为94%，而当NLR高于5.04时，CT严重改变的概率仅为50%。对于嗜酸性粒细胞，0.35%的值对应胸部CT严重程度为2（灵敏度=0.88，特异度=0.43，曲线下面积=0.661，95%可信区间（0.544；0.779），p=0.021）。COVID-19患者的NLR和PLR值显著更高。在我们的研究中，NLR=2.90和PLR=186具有良好的特异性（分别为0.89，p=0.001；0.92，p<0.001）。NLR、PLR水平升高应促使临床医生开具胸部CT检查，因为这可能揭示影响患者未来治疗的重要病变。
