Fors Martha, Ballaz Santiago, Ramírez Hegira, Mora Francisco X, Pulgar-Sánchez Mary, Chamorro Kevin, Fernández-Moreira Esteban
Escuela de Medicina, Universidad de las Américas-UDLA, Quito, Ecuador.
School of Biological Sciences and Engineering, Universidad Yachay Tech, Ibarra, Ecuador.
Front Cardiovasc Med. 2022 Apr 8;9:822556. doi: 10.3389/fcvm.2022.822556. eCollection 2022.
The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and mean platelet volume-to-platelet ratio (MPR) are combined hematology tests that predict COVID-19 severity, although with different cut-off values. Because sex significantly impacts immune responses and the course of COVID-19, the ratios could be biased by sex.
This study aims to evaluate sex-dependent differences in the contribution of NLR, PLR, MLR, and MPR to COVID-19 severity and mortality upon hospital admission using a sample of pneumonia patients with SARS-CoV-2 infection.
This single-center observational cross-sectional study included 3,280 confirmed COVID-19 cases (CDC 2019-Novel Coronavirus real-time RT-PCR Diagnostic) from Quito (Ecuador). The receiver operating characteristic (ROC) curve analysis was conducted to identify optimal cut-offs of the above parameters when discriminating severe COVID-19 pneumonia and mortality risks after segregation by sex. Severe COVID-19 pneumonia was defined as having PaO < 60 mmHg and SpO < 94%, whereas non-severe COVID-19 pneumonia was defined as having PaO ≥ 60 mmHg and SpO ≥ 94%.
The mortality rate of COVID-19 among men was double that in women. Severe COVID-19 pneumonia and non-surviving patients had a higher level of NLR, MLR, PLR, and MPR. The medians of NLR, MLR, and MPR in men were significantly higher, but PLR was not different between men and women. In men, these ratios had lower cut-offs than in women (NLR: 2.42 vs. 3.31, MLR: 0.24 vs. 0.35, and PLR: 83.9 vs. 151.9). The sensitivity of NLR, MLR, and PLR to predict pneumonia severity was better in men (69-77%), whereas their specificity was enhanced in women compared to men (70-76% vs. 23-48%).
These ratios may represent widely available biomarkers in COVID-19 since they were significant predictors for disease severity and mortality although with different performances in men and women.
中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）以及平均血小板体积与血小板比值（MPR）是综合血液学检测指标，可预测新冠病毒疾病（COVID-19）的严重程度，尽管其临界值不同。由于性别会显著影响免疫反应及COVID-19的病程，这些比值可能存在性别偏倚。
本研究旨在利用感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的肺炎患者样本，评估入院时NLR、PLR、MLR和MPR对COVID-19严重程度和死亡率影响的性别差异。
这项单中心观察性横断面研究纳入了来自基多（厄瓜多尔）的3280例确诊COVID-19病例（美国疾病控制与预防中心2019新型冠状病毒实时逆转录聚合酶链反应诊断法）。通过绘制受试者工作特征（ROC）曲线，确定上述参数在按性别分层后区分重症COVID-19肺炎和死亡风险时的最佳临界值。重症COVID-19肺炎定义为动脉血氧分压（PaO）<60 mmHg且动脉血氧饱和度（SpO）<94%，而非重症COVID-19肺炎定义为PaO≥60 mmHg且SpO≥94%。
COVID-19男性死亡率是女性的两倍。重症COVID-19肺炎患者和死亡患者的NLR、MLR、PLR和MPR水平更高。男性的NLR、MLR和MPR中位数显著更高，但PLR在男性和女性之间无差异。在男性中，这些比值的临界值低于女性（NLR：2.42对3.31，MLR：0.24对0.35，PLR：83.9对151.9）。NLR、MLR和PLR预测肺炎严重程度的敏感性在男性中更高（69 - 77%），而其特异性在女性中高于男性（70 - 76%对23 - 48%）。
这些比值可能是COVID-19中广泛可用的生物标志物，因为它们是疾病严重程度和死亡率的重要预测指标，尽管在男性和女性中的表现有所不同。
