Regolo Matteo, Sorce Alessandra, Vaccaro Mauro, Colaci Michele, Stancanelli Benedetta, Natoli Giuseppe, Motta Massimo, Isaia Ivan, Castelletti Federica, Giangreco Federica, Fichera Daniela, Aparo Paola, Lanzafame Alessandra, Russo Mario, Santangelo Nicola, Noto Paola, Malatino Lorenzo
Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy.
J Clin Med. 2023 Jun 15;12(12):4057. doi: 10.3390/jcm12124057.
All severe cases of SARS-CoV-2 infections are characterized by a high risk of disease progression towards ARDS, leading to a bad outcome. Respiratory symptoms in COVID-19 patients often do not correspond to disease's worsening. In our sample, median age was 74 years (72-75) and 54% were men. The median period of hospitalization was 9 days. Firstly, we observed a significant asynchronous trend of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in 764 selected among 963 patients, who were consecutively recruited in two hospitals (Cannizzaro, S. Marco) in Catania, Italy. NLR values in deceased patients showed an increase from baseline over time. By contrast, CRP tended to fall from baseline to median day of hospitalization in all three subgroups, but steeply increased at the end of hospitalization only in ICU-admitted patients. Then, we evaluated the relationships between NLR and CRP as continuous variables with PaO/FiO ratio (P/F). NLR was an independent predictor of mortality (HR: 1.77, < 0.0001), while ICU admission was more significantly associated with CRP (HR: 1.70, < 0.0001). Finally, age, neutrophils, CRP, and lymphocytes are significantly and directly linked to P/F, while the influence of inflammation on P/F, reflected by CRP, was also mediated by neutrophils.
所有严重的新型冠状病毒2感染病例的特点是疾病进展为急性呼吸窘迫综合征的风险很高，导致不良后果。新冠病毒肺炎患者的呼吸道症状往往与疾病恶化情况不符。在我们的样本中，中位年龄为74岁（72 - 75岁），54%为男性。中位住院时间为9天。首先，我们在意大利卡塔尼亚的两家医院（坎尼扎罗医院、圣马尔科医院）连续招募的963名患者中选取的764名患者中观察到中性粒细胞与淋巴细胞比值（NLR）和C反应蛋白（CRP）存在显著的异步趋势。死亡患者的NLR值随时间从基线开始升高。相比之下，在所有三个亚组中，CRP从基线到住院中位日呈下降趋势，但仅在入住重症监护病房的患者中，在住院末期急剧上升。然后，我们将NLR和CRP作为连续变量与动脉血氧分压/吸入氧浓度比值（P/F）进行相关性评估。NLR是死亡率的独立预测因子（风险比：1.77，P < 0.000），而入住重症监护病房与CRP的相关性更强（风险比：1.70，P < 0.000）。最后，年龄、中性粒细胞、CRP和淋巴细胞与P/F显著且直接相关，而由CRP反映的炎症对P/F的影响也由中性粒细胞介导。
