Liu Alexander, Hammond Robert, Chan Kenneth, Chukwuenweniwe Chukwugozie, Johnson Rebecca, Khair Duaa, Duck Eleanor, Olubodun Oluwaseun, Barwick Kristian, Banya Winston, Stirrup James, Donnelly Peter D, Kaski Juan Carlos, Coates Anthony R M
School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK.
Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK.
Biomedicines. 2023 Oct 18;11(10):2819. doi: 10.3390/biomedicines11102819.
The ferritin-lymphocyte ratio (FLR) is a novel inflammatory biomarker for the assessment of acute COVID-19 patients. However, the prognostic value of FLR for predicting adverse clinical outcomes in COVID-19 remains unclear, which hinders its clinical translation. We characterised the prognostic value of FLR in COVID-19 patients, as compared to established inflammatory markers. In 217 study patients (69 years [IQR: 55-82]; 60% males), FLR was weakly correlated with CRP (R = 0.108, = 0.115) and white cell count (R = -0.144; = 0.034). On ROC analysis, an FLR cut-off of 286 achieved a sensitivity of 86% and a specificity of 30% for predicting inpatient mortality (AUC 0.60, 95% CI: 0.53-0.67). The negative predictive values of FLR for ruling out mortality, non-invasive ventilation requirement and critical illness (intubation and/or ICU admission) were 86%, 85% and 93%, respectively. FLR performed similarly to CRP (AUC 0.60 vs. 0.64; = 0.375) for predicting mortality, but worse than CRP for predicting non-fatal outcomes (all < 0.05). On Kaplan-Meier analysis, COVID-19 patients with FLR values > 286 had worse inpatient survival than patients with FLR ≤ 286, = 0.041. FLR has prognostic value in COVID-19 patients, and appears unrelated to other inflammatory markers such as CRP and WCC. FLR exhibits high sensitivity and negative predictive values for adverse clinical outcomes in COVID-19, and may be a good "rule-out" test. Further work is needed to improve the sensitivity of FLR and validate its role in prospective studies for guiding clinical management.
铁蛋白-淋巴细胞比值（FLR）是一种用于评估急性新冠肺炎患者的新型炎症生物标志物。然而，FLR对预测新冠肺炎不良临床结局的预后价值仍不明确，这阻碍了其临床应用。我们将FLR与已确立的炎症标志物进行比较，以明确其在新冠肺炎患者中的预后价值。在217例研究患者中（年龄69岁[四分位间距：55-82]；60%为男性），FLR与CRP（R = 0.108，P = 0.115）和白细胞计数（R = -0.144；P = 0.034）呈弱相关。在ROC分析中，FLR临界值为286时，预测住院患者死亡率的灵敏度为86%，特异度为30%（AUC 0.60，95%CI：0.53-0.67）。FLR排除死亡率、无创通气需求和危重症（插管和/或入住ICU）的阴性预测值分别为86%、85%和93%。在预测死亡率方面，FLR的表现与CRP相似（AUC 0.60对0.64；P = 0.375），但在预测非致命结局方面比CRP差（所有P<0.05）。根据Kaplan-Meier分析，FLR值>286的新冠肺炎患者住院生存率低于FLR≤286的患者，P = 0.041。FLR在新冠肺炎患者中具有预后价值，且似乎与CRP和WCC等其他炎症标志物无关。FLR对新冠肺炎不良临床结局具有高灵敏度和阴性预测值，可能是一种良好的“排除”检测方法。需要进一步开展工作以提高FLR的灵敏度，并在前瞻性研究中验证其在指导临床管理方面的作用。
