Bardakci Okan, Das Murat, Akdur Gökhan, Akman Canan, Siddikoglu Duygu, Akdur Okhan, Beyazit Yavuz
Department of Emergency Medicine, Canakkale Onsekiz Mart University, 17020, Canakkale, Turkey.
Department of Biostatistic, Canakkale Onsekiz Mart University, 17020, Canakkale, Turkey.
Natl Med J India. 2022 Jul-Aug;35(4):221-228. doi: 10.25259/NMJI_474_21.
Background Mortality due to Covid-19 and severe community-acquired pneumonia (CAP) remains high, despite progress in critical care management. We compared the precision of CURB-65 score with monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) in prediction of mortality among patients with Covid-19 and CAP presenting to the emergency department. Methods We retrospectively analysed two cohorts of patients admitted to the emergency department of Canakkale University Hospital, namely (i) Covid-19 patients with severe acute respiratory symptoms presenting between 23 March 2020 and 31 October 2020, and (ii) all patients with CAP either from bacterial or viral infection within the 36 months preceding the Covid-19 pandemic. Mortality was defined as in-hospital death or death occurring within 30 days after discharge. Results The first study group consisted of 324 Covid-19 patients and the second group of 257 CAP patients. The non-survivor Covid-19 group had significantly higher MLR, NLR and PLR values. In univariate analysis, in Covid-19 patients, a 1-unit increase in NLR and PLR was associated with increased mortality, and in multivariate analysis for Covid-19 patients, age and NLR remained significant in the final step of the model. According to this model, we found that in the Covid-19 group an increase in 1-unit in NLR would result in an increase by 5% and 7% in the probability of mortality, respectively. According to pairwise analysis, NLR and PLR are as reliable as CURB-65 in predicting mortality in Covid-19. Conclusions Our study indicates that NLR and PLR may serve as reliable predictive factors as CURB-65 in Covid-19 pneumonia, which could easily be used to triage and manage severe patients in the emergency department.
尽管在重症监护管理方面取得了进展，但新冠病毒病（Covid-19）和重症社区获得性肺炎（CAP）导致的死亡率仍然很高。我们比较了CURB-65评分与单核细胞与淋巴细胞比值（MLR）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）在预测急诊科就诊的Covid-19和CAP患者死亡率方面的准确性。方法：我们回顾性分析了恰纳卡莱大学医院急诊科收治的两组患者，即（i）2020年3月23日至2020年10月31日期间出现严重急性呼吸道症状的Covid-19患者，以及（ii）在Covid-19大流行前36个月内所有因细菌或病毒感染导致的CAP患者。死亡率定义为住院死亡或出院后30天内死亡。结果：第一个研究组由324例Covid-19患者组成，第二个组由257例CAP患者组成。Covid-19非存活组的MLR、NLR和PLR值显著更高。在单因素分析中，在Covid-19患者中，NLR和PLR每增加1个单位与死亡率增加相关，在Covid-19患者的多因素分析中，年龄和NLR在模型的最后一步仍然显著。根据该模型，我们发现在Covid-19组中，NLR每增加1个单位，死亡概率分别增加5%和7%。根据成对分析，NLR和PLR在预测Covid-19死亡率方面与CURB-65一样可靠。结论：我们的研究表明，NLR和PLR在Covid-19肺炎中可能作为与CURB-65一样可靠的预测因素，可轻松用于急诊科对重症患者进行分诊和管理。
