Internal Medicine Department, Hospital Clínico de Santiago, 15706 Santiago de Compostela, Spain.
Sanitary Research Institute of Santiago, 15706 Santiago de Compostela, Spain.
Viruses. 2024 Feb 22;16(3):335. doi: 10.3390/v16030335.
This study aimed to validate the role of the D-dimer to lymphocyte ratio (DLR) for mortality prediction in a large national cohort of hospitalized coronavirus disease 2019 (COVID-19) patients.
A retrospective, multicenter, observational study that included hospitalized patients due to SARS-CoV-2 infection in Spain was conducted from March 2020 to March 2022. All biomarkers and laboratory indices analyzed were measured once at admission.
A total of 10,575 COVID-19 patients were included in this study. The mean age of participants was 66.9 (±16) years, and 58.6% (6202 patients) of them were male. The overall mortality rate was 16.3% ( = 1726 patients). Intensive care unit admission was needed in 10.5% ( = 1106 patients), non-invasive mechanical ventilation was required in 8.8% ( = 923 patients), and orotracheal intubation was required in 7.5% (789 patients). DLR presented a c-statistic of 0.69 (95% CI, 0.68-0.71) for in-hospital mortality with an optimal cut-off above 1. Multivariate analysis showed an independent association for in-hospital mortality for DLR > 1 (adjusted OR 2.09, 95% CI 1.09-4.04; = 0.03); in the same way, survival analysis showed a higher mortality risk for DLR > 1 (HR 2.24; 95% CI 2.03-2.47; < 0.01). Further, no other laboratory indices showed an independent association for mortality in multivariate analysis.
This study confirmed the usefulness of DLR as a prognostic biomarker for mortality associated with SARS-CoV-2 infection, being an accessible, cost-effective, and easy-to-use biomarker in daily clinical practice.
本研究旨在验证 D-二聚体与淋巴细胞比值（DLR）在大型西班牙住院 2019 冠状病毒病（COVID-19）患者队列中对死亡率预测的作用。
这是一项回顾性、多中心、观察性研究，纳入了 2020 年 3 月至 2022 年 3 月期间因 SARS-CoV-2 感染住院的患者。所有分析的生物标志物和实验室指标均在入院时测量一次。
本研究共纳入 10575 例 COVID-19 患者。参与者的平均年龄为 66.9（±16）岁，其中 58.6%（6202 例）为男性。总体死亡率为 16.3%（=1726 例）。需要入住重症监护病房的患者占 10.5%（=1106 例），需要无创机械通气的患者占 8.8%（=923 例），需要经口气管插管的患者占 7.5%（=789 例）。DLR 对住院死亡率的 C 统计量为 0.69（95%CI，0.68-0.71），最佳截断值为 1 以上。多变量分析显示，DLR>1 与住院死亡率独立相关（调整后的 OR 2.09，95%CI 1.09-4.04；=0.03）；同样，生存分析显示 DLR>1 的死亡率风险更高（HR 2.24；95%CI 2.03-2.47；<0.01）。此外，多变量分析中没有其他实验室指标与死亡率独立相关。
本研究证实了 DLR 作为与 SARS-CoV-2 感染相关死亡率的预后生物标志物的有用性，是一种在日常临床实践中易于获取、具有成本效益且易于使用的生物标志物。
