Pluta Michał P, Zachura Mateusz N, Winiarska Katarzyna, Kalemba Alicja, Kapłan Cezary, Szczepańska Anna J, Krzych Łukasz J
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 14 Street, 40752 Katowice, Poland.
Emergency Medicine Department, St. Barbara's Memorial Hospital No. 5 Trauma Center, Medyków 1 Square, 41200 Sosnowiec, Poland.
J Clin Med. 2022 Feb 15;11(4):1011. doi: 10.3390/jcm11041011.
Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19.
Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge.
Patients who died had higher NLR on admission (20.3, IQR 15.3-30.2 vs. 11.0, IQR 6.8-16.9; = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1-50.5 vs. 43.9 fL; IQR 40.9-47.3, = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65-0.86; = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60-0.82; = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61-96.29, = 0.02), independent of other blood counts, clinical and demographic parameters.
Neutrophil-lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19.
免疫失调和低氧血症是新型冠状病毒肺炎（COVID-19）患者中影响外周血细胞计数参数的两个重要病理生理问题。我们假设，评估中性粒细胞与淋巴细胞比值（NLR）和红细胞分布宽度标准差（RDW-SD）可以预测重型和危重型COVID-19患者的死亡情况。
本研究纳入了70例因COVID-19急性呼吸衰竭入住重症监护病房（ICU）的患者。评估了患者入住ICU当天的RDW-SD和NLR以及整个住院期间的峰值。主要终点是ICU出院前死亡。
死亡患者入院时的NLR（20.3，四分位间距15.3 - 30.2 vs. 11.0，四分位间距6.8 - 16.9；P = 0.003）和RDW-SD（48.1 fL；四分位间距43.1 - 50.5 vs. 43.9 fL；四分位间距40.9 - 47.3，P = 0.01）高于从ICU出院的患者。入住ICU当天的NLR和RDW-SD值分别在76%（曲线下面积[AUC]=0.76；95%置信区间[CI] 0.65 - .86；P = 0.001；临界值>14.38）和72%的病例中准确预测了死亡（AUC = 0.72；95%CI 0.60 - 0.8；P = .003；临界值>44.7 fL）。多变量分析证实，入住ICU当天NLR>14.38与死亡风险增加12倍相关（对数比值比12.43；95%CI 1.61 - 96.29，P = 0.0），独立于其他血细胞计数、临床和人口统计学参数。
入住ICU当天测定的中性粒细胞与淋巴细胞比值可能是预测重型和危重型COVID-19患者死亡的有用生物标志物。
