Tadesse Zelalem, Bekele Bayissa Abdi, Diriba Tolesa, Chernet Nahom, Tsegaye Seniat, Tsega Molla
Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Int J Gen Med. 2022 Aug 23;15:6739-6755. doi: 10.2147/IJGM.S375565. eCollection 2022.
Early identification of patients at high risk of poor clinical outcomes is the key to success in saving the lives of patients with coronavirus disease 2019 (COVID-19). Neutrophil to Lymphocyte Ratio (NLR) is an easily available and cheap surrogate inflammatory marker, its baseline NLR role in African COVID-19 patients remains to be investigated. The objective of the study aimed to evaluate the role of NLR as a predictor of severity and mortality of COVID-19 patients admitted at the Millennium COVID 19 care center in Addis Ababa, Ethiopia.
A cross-sectional study was conducted on patients with COVID-19 admitted to the Millennium COVID-19 care center from August 1 to October 30, 2021. Receiver Operating Characteristic curve analysis was used to calculate the area under the curve to assess the predictive capacity of NLR on mortality and severity. Multivariable logistic regression analysis was done to identify the association between independent variables and disease outcomes with an Adjusted Odds Ratio (AOR), P-value, and 95% CI for AOR were used for testing significance.
The NLR of 9.47 was identified as the optimal cut-off value for predicting mortality with a sensitivity of 88.7% and a specificity of 95.4% (Area Under the Curve (AUC):0.95, 95% CI 0.92-98; P<0.001) and the NLR of 5.86 was an effective threshold value in predicting the severity of disease with a sensitivity of 92.2% and a specificity of 75% (AUC:0.85, 95% CI 0.800-0.905; P<0.001). In multivariable logistic regression analysis, after adjusting for confounding factors, NLR of more than 9.47 and 5.86 was significantly associated with all-cause of in-hospital mortality (AOR=4.73, 95% CI, 1.19-33.68; P<0.02), and severity of disease (AOR=12.98, 95% CI 3.85-43.80; P=0.001), respectively.
NLR greater than 9.47 and 5.86 effectively predict mortality and severity of the disease, respectively. It provides an objective input for early decision-making in inpatient management especially in resources limited area.
早期识别临床预后不良风险高的患者是挽救2019冠状病毒病（COVID-19）患者生命的关键。中性粒细胞与淋巴细胞比值（NLR）是一种易于获取且成本低廉的替代性炎症标志物，其在非洲COVID-19患者中的基线NLR作用仍有待研究。本研究的目的是评估NLR作为埃塞俄比亚亚的斯亚贝巴千禧COVID-19护理中心收治的COVID-19患者严重程度和死亡率预测指标的作用。
对2021年8月1日至10月30日在千禧COVID-19护理中心收治的COVID-19患者进行了一项横断面研究。采用受试者操作特征曲线分析来计算曲线下面积，以评估NLR对死亡率和严重程度的预测能力。进行多变量逻辑回归分析，以确定自变量与疾病结局之间的关联，并使用调整后的比值比（AOR）、P值和AOR的95%置信区间来检验显著性。
NLR为9.47被确定为预测死亡率的最佳临界值，敏感性为88.7%，特异性为95.4%（曲线下面积（AUC）：0.95，95%置信区间0.92 - 98；P<0.001），NLR为5.86是预测疾病严重程度的有效阈值，敏感性为92.2%，特异性为75%（AUC：0.85，95%置信区间0.800 - 0.905；P<0.001）。在多变量逻辑回归分析中，在调整混杂因素后，NLR大于9.47和5.86分别与全因院内死亡率（AOR = 4.73，95%置信区间，1.19 - 33.68；P<0.02）和疾病严重程度（AOR = 12.98，95%置信区间3.85 - 43.80；P = 0.001）显著相关。
NLR大于9.47和5.86分别有效预测疾病的死亡率和严重程度。它为住院管理中的早期决策提供了客观依据，尤其是在资源有限的地区。
