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中性粒细胞与淋巴细胞比值和其他炎症标志物可预测住院 COVID-19 患者的不良结局。

Neutrophil to lymphocytic ratio and other inflammatory markers as adverse outcome predictor in hospitalized COVID-19 patients.

机构信息

Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Department of Infectious Diseases & Gastroenterology & Hepatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

出版信息

Egypt J Immunol. 2022 Apr;29(2):57-67.

Abstract

Early risk classification of coronavirus disease 2019 (COVID-19) patients admitted to hospital is a critical key for providing optimal interventions. We investigated whether neutrophil-to-lymphocyte ratio (NLR) levels and other inflammatory and coagulation markers could be predictors for the severity and mortality of hospitalized COVID-19 patients. This cross-sectional study included 155 COVID-19 patients diagnosed by the reverse transcription polymerase chain reaction (RT-PCR) using oropharyngeal swabs. All patients had clinical examination, routine laboratory investigation, and chest computerized tomography scan. O2 saturation, serum D dimer, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and serum ferritin were assessed. NLR can predict the adverse outcome (e.g., disease deterioration and shock) at cut-off 6.65, with 92% sensitivity and 20.7% specificity. LDH at cut-off value of 364.5 had 79.3% sensitivity and 47% specificity. Ferritin at a cut-off value of 1036 had 60.9% sensitivity and 60.6% specificity. NLR alone was not an independent predictor for ICU, however, combining NLR with ferritin and LDH predicted the need for ICU. Total leucocytic count (TLC), neutrophil count, lymphocytic count, D dimer, and CRP were independent predictors for the need of ICU admission (P < 0.05). Admitted patients to ICU and dead patients had higher COVID-19 Reporting and Data System, length of stay, LDH, and ferritin and lower O2 saturation than non-admitted and alive ones. We concluded that NLR with ferritin and LDH markers had higher degree of sensitivity and specificity in detecting adverse outcomes in COVID-19 patients. Other inflammatory biomarkers such as TLC, neutrophil, lymphocyte, D dimer, and CRP were predictive in this case.

摘要

早期对 2019 年冠状病毒病(COVID-19)住院患者进行风险分类是提供最佳干预措施的关键。我们研究了中性粒细胞与淋巴细胞比值(NLR)水平和其他炎症及凝血标志物是否可作为预测住院 COVID-19 患者严重程度和死亡率的指标。本横断面研究纳入了 155 例经咽拭子逆转录聚合酶链反应(RT-PCR)确诊的 COVID-19 患者。所有患者均进行了临床检查、常规实验室检查和胸部计算机断层扫描。评估了血氧饱和度、血清 D 二聚体、C 反应蛋白(CRP)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)和血清铁蛋白。NLR 预测不良结局(如病情恶化和休克)的截断值为 6.65,灵敏度为 92%,特异性为 20.7%。LDH 的截断值为 364.5 时,灵敏度为 79.3%,特异性为 47%。铁蛋白的截断值为 1036 时,灵敏度为 60.9%,特异性为 60.6%。NLR 本身不是 ICU 入住的独立预测因素,但 NLR 与铁蛋白和 LDH 联合预测需要入住 ICU。白细胞总数(TLC)、中性粒细胞计数、淋巴细胞计数、D 二聚体和 CRP 是 ICU 入住的独立预测因素(P < 0.05)。入住 ICU 的患者和死亡患者的 COVID-19 报告和数据系统评分、住院时间、LDH 和铁蛋白水平较低,血氧饱和度较高,而非入住 ICU 和存活患者则相反。我们得出结论,NLR 联合铁蛋白和 LDH 标志物在检测 COVID-19 患者不良结局方面具有更高的灵敏度和特异性。其他炎症生物标志物,如 TLC、中性粒细胞、淋巴细胞、D 二聚体和 CRP,在这种情况下也具有预测作用。

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