Anaesthesia Department, Hospital Universitario HM Sanchinarro, Madrid, Spain.
Anaesthesia Department, Hospital Universitario Santa Cristina, Madrid, Spain.
BMC Emerg Med. 2021 Jul 27;21(1):89. doi: 10.1186/s12873-021-00480-w.
The vast impact of COVID-19 call for the identification of clinical parameter that can help predict a torpid evolution. Among these, endothelial injury has been proposed as one of the main pathophysiological mechanisms underlying the disease, promoting a hyperinflammatory and prothrombotic state leading to worse clinical outcomes. Leukocytes and platelets play a key role in inflammation and thrombogenesis, hence the objective of the current study was to study whether neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), the systemic immune-inflammation index (SII) as well as the new parameter neutrophil-to-platelet ratio (NPR), could help identify patients who at risk of admission at Intensive Care Units.
A retrospective observational study was performed at HM Hospitales including electronic health records from 2245 patients admitted due to COVID-19 from March 1 to June 10, 2020. Patients were divided into two groups, admitted at ICU or not.
Patients who were admitted at the ICU had significantly higher values in all hemogram-derived ratios at the moment of hospital admission compared to those who did not need ICU admission. Specifically, we found significant differences in NLR (6.9 [4-11.7] vs 4.1 [2.6-7.6], p < 0.0001), PLR (2 [1.4-3.3] vs 1.9 [1.3-2.9], p = 0.023), NPR (3 [2.1-4.2] vs 2.3 [1.6-3.2], p < 0.0001) and SII (13 [6.5-25.7] vs 9 [4.9-17.5], p < 0.0001) compared to those who did not require ICU admission. After multivariable logistic regression models, NPR was the hemogram-derived ratio with the highest predictive value of ICU admission, (OR 1.11 (95% CI: 0.98-1.22, p = 0.055).
Simple, hemogram-derived ratios obtained from early hemogram at hospital admission, especially the novelty NPR, have shown to be useful predictors of risk of ICU admission in patients hospitalized due to COVID-19.
COVID-19 的广泛影响要求我们确定能够帮助预测疾病进展缓慢的临床参数。在这些参数中，内皮损伤被认为是疾病主要病理生理机制之一，可导致过度炎症和促血栓形成状态，从而导致更差的临床结局。白细胞和血小板在炎症和血栓形成中发挥关键作用，因此本研究旨在研究中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）以及新参数中性粒细胞与血小板比值（NPR）是否有助于识别有入住重症监护病房（ICU）风险的患者。
这是一项在 HM Hospitales 进行的回顾性观察性研究，纳入了 2020 年 3 月 1 日至 6 月 10 日因 COVID-19 住院的 2245 例患者的电子健康记录。患者分为入住 ICU 组和未入住 ICU 组。
入住 ICU 的患者在入院时所有基于血常规的比值均显著高于无需入住 ICU 的患者。具体而言，我们发现 NLR（6.9 [4-11.7] 与 4.1 [2.6-7.6]，p<0.0001）、PLR（2 [1.4-3.3] 与 1.9 [1.3-2.9]，p=0.023）、NPR（3 [2.1-4.2] 与 2.3 [1.6-3.2]，p<0.0001）和 SII（13 [6.5-25.7] 与 9 [4.9-17.5]，p<0.0001）的差异有统计学意义。多变量逻辑回归模型后，NPR 是 ICU 入住的预测值最高的血常规衍生比值（OR 1.11 [95%CI：0.98-1.22，p=0.055）。
从住院时早期血常规中获得的简单血常规衍生比值，特别是新颖的 NPR，已被证明是预测 COVID-19 住院患者入住 ICU 风险的有用指标。
