中性粒细胞与淋巴细胞比值作为2019冠状病毒病疾病严重程度和死亡率的预测指标：来自印度中部的前瞻性研究
Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India.
作者信息
Rathod Bharatsing D, Amle Dnyanesh, Khot Rajashree S, Prathipati Kiran Kumar, Joshi Prashant P
机构信息
General Medicine, All India Institute of Medical Sciences, Nagpur, IND.
Biochemistry, All India Institute of Medical Sciences, Nagpur, IND.
出版信息
Cureus. 2022 Mar 31;14(3):e23696. doi: 10.7759/cureus.23696. eCollection 2022 Mar.
BACKGROUND
Clinical presentation of coronavirus disease 2019 (COVID-19) varies from an asymptomatic state to severe disease characterized by acute respiratory distress syndrome, respiratory failure, thrombosis, and multi-organ dysfunction syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been reviewed as one of the laboratory factors that have been proposed to predict the severity of disease and mortality in COVID-19 pandemic.
AIM AND OBJECTIVES
To evaluate the association between NLR and the disease severity and mortality in COVID-19.
MATERIALS AND METHODS
After approval from Institutional Ethics Committee, this prospective cohort study was carried out in a tertiary-care teaching medical institute of Central India. COVID-19 patients of the age group 18 years and above admitted during the study period were included. Cases were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. NLR was calculated by doing a complete blood count at the time of hospitalization by the Mindray BC-6000 auto hematology analyzer. The outcome of the disease was classified as recovery and death during hospitalization. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of NLR at admission to predict severe COVID-19 or mortality. Ordinal regression analysis was used to assess the impact of NLR on disease severity and mortality.
RESULTS
Mean NLR was significantly higher in the severe COVID-19 group as compared to the mild/moderate group and in deceased as compared to discharged cases. ROC curve analysis revealed NLR to be an excellent predictor of disease severity as well as a prognostic parameter for risk of death. NLR was found to be a significant independent positive predictor for contracting the severe disease (Odd's ratio 1.396, 95% CI=1.112-1.753, p=0.004) and mortality (Odd's ratio 1.276, 95% CI=1.085-1.499, p=0.003).
CONCLUSION
High NLR was significantly associated with the disease severity and mortality in COVID-19.
背景
2019冠状病毒病（COVID-19）的临床表现各不相同，从无症状状态到以急性呼吸窘迫综合征、呼吸衰竭、血栓形成和多器官功能障碍综合征为特征的严重疾病。中性粒细胞与淋巴细胞比值（NLR）已被视为在COVID-19大流行中用于预测疾病严重程度和死亡率的实验室指标之一。
目的
评估NLR与COVID-19疾病严重程度和死亡率之间的关联。
材料与方法
经机构伦理委员会批准后，在印度中部一所三级护理教学医学院开展了这项前瞻性队列研究。纳入研究期间收治的18岁及以上的COVID-19患者。根据临床症状、呼吸频率、血氧饱和度和胸部影像学检查，将病例分为四组：无症状组（A组）、轻症组（B组）、中症组（C组）和重症组（D组）。通过迈瑞BC-6000全自动血液分析仪在住院时进行全血细胞计数来计算NLR。疾病结局分为住院期间康复和死亡。采用受试者工作特征（ROC）曲线分析来评估入院时NLR预测重症COVID-19或死亡的能力。采用有序回归分析来评估NLR对疾病严重程度和死亡率的影响。
结果
与轻症/中症组相比，重症COVID-19组的平均NLR显著更高；与出院病例相比，死亡病例的平均NLR显著更高。ROC曲线分析显示，NLR是疾病严重程度的优秀预测指标，也是死亡风险的预后参数。发现NLR是罹患重症疾病（比值比1.396，95%置信区间=1.112-1.753，p=0.004）和死亡（比值比1.276，95%置信区间=1.085-1.499，p=0.003）的显著独立阳性预测指标。
结论
高NLR与COVID-19的疾病严重程度和死亡率显著相关。
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