[新冠病毒疾病中中性粒细胞淋巴细胞比值与死亡率的关系]

[Delta of neutrophil lymphocyte index and mortality in covid-19 disease].

作者信息

Rosales-López Sandra Luz, Fernández-Hernández Juan Pablo, Hernández-González Martha Alicia, Solorio-Meza Sergio Eduardo, González-Carrillo Pedro Luis, Guardado-Mendoza Rodolfo

机构信息

Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 Bajío, Unidad de Cuidados Intensivos. León, Guanajuato, México.

Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 Bajío, División de Investigación en Salud. León, Guanajuato, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2022 Oct 25;60(6):640-648.

BACKGROUND

Acute respiratory distress syndrome, due to SARS-CoV-2, is a worldwide health problem. The neutrophil-lymphocyte index allows risk stratification in patients with severe and poor prognostic data, since it reflects the inflammatory state.

OBJECTIVE

To determine whether the Neutrophil-Lymphocyte Index delta predicts mortality in patients with COVID-19.

MATERIAL AND METHODS

We conducted a longitudinal, comparative study in patients with COVID-19, older than 18 years, admitted to the ICU. We evaluated HAS, DM, obesity, COPD, asthma, PaO2/FiO2, tomographic severity. On admission and on days 3 and 7 we measured Neutrophil-Lymphocyte Index, SOFA and APACHE score. For statistical analysis, we performed ROC and Kaplan-Meyer curves.

RESULTS

We included 180 patients with COVID-19, 63 died (35%). Delta INL1(Day1-day3)>4.11 was associated with mortality (AUC:0.633); sensitivity 55.56% and specificity 77.78%, CI95 0.55-0.70, for delta INL2 (Day1-day7)>8.95 (AUC:0.623); sensitivity 44.44% and specificity 84.62%, CI95 0.54-0.69. Difference in survival was observed for Delta1. SOFA scale >6, was associated with more days of mechanical ventilation and lower PaO2/FiO2 (p<0.001).

CONCLUSIONS

INL delta between the day of ICU admission and the 3rd day of evolution is a predictor of mortality in critically ill patients.

背景

由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的急性呼吸窘迫综合征是一个全球性的健康问题。中性粒细胞与淋巴细胞比值可用于对预后严重不良的患者进行风险分层，因为它反映了炎症状态。

目的

确定中性粒细胞与淋巴细胞比值变化是否可预测2019冠状病毒病（COVID-19）患者的死亡率。

材料与方法

我们对入住重症监护病房（ICU）的18岁以上COVID-19患者进行了一项纵向比较研究。我们评估了高血压、糖尿病、肥胖、慢性阻塞性肺疾病（COPD）、哮喘、动脉血氧分压/吸入氧分数值（PaO2/FiO2）、影像学严重程度。在入院时以及第3天和第7天，我们测量了中性粒细胞与淋巴细胞比值、序贯器官衰竭评估（SOFA）评分和急性生理与慢性健康状况评分系统（APACHE）评分。为了进行统计分析，我们绘制了受试者工作特征（ROC）曲线和Kaplan-Meyer曲线。

结果

我们纳入了180例COVID-19患者，其中63例死亡（35%）。入院第1天至第3天中性粒细胞与淋巴细胞比值变化（Delta INL1）>4.11与死亡率相关（曲线下面积[AUC]：0.633）；入院第1天至第7天中性粒细胞与淋巴细胞比值变化（Delta INL2）>8.95时，敏感性为55.56%，特异性为77.78%，95%置信区间（CI）为0.55 - 0.70，AUC为0.623；敏感性为44.44%，特异性为84.62%，CI95为0.54 - 0.69。观察到Delta1在生存方面存在差异。SOFA评分>6与机械通气天数增加和PaO2/FiO2降低相关（p<0.001）。