Pui Mihai Claudiu, Butiulca Mihaela, Cehan Vlad, Stoica Florin, Lazar Alexandra
Department of Anesthesiology and Intensive Care Medicine, Emergency County Hospital, Targu Mures, Romania.
Department of Anesthesiology and Intensive Care Medicine, Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania.
J Crit Care Med (Targu Mures). 2024 Jan 30;10(1):49-55. doi: 10.2478/jccm-2024-0005. eCollection 2024 Jan.
Acute respiratory distress syndrome (ARDS) represents a major cause of mortality in the intensive care unit (ICU). The inflammatory response is escalated by the cytokines and chemokines released by neutrophils, therefore the search for quantifying the impact of this pathophysiological mechanism is imperative. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are indicators of systemic inflammation, widely accessible, inexpensive, and uncomplicated parameters.
We conducted a prospective study between March 2023 and June 2023 on patients which presented Berlin criteria for the diagnosis of ARDS during the first 24 hours from admission in the ICU. We included 33 patients who were divided into two groups: one group of 11 patients with severe ARDS and the second group of 22 patients with moderate/mild ARDS. The study evaluated demographic characteristics, leukocyte, lymphocyte, neutrophil, and platelet counts, as well as NLR and PLR values from complete blood count, and severity scores (APACHE II score and SOFA score). We investigated the correlation of NLR and PLR in the two main groups (severe and moderate/mild acute respiratory distress syndrome patients).
For the NLR ratio statistically significant differences between the two groups are noted: Severe ARDS 24.29(1.13-96) vs 15.67(1.69-49.71), p=0.02 For the PLR ratio, we obtained significant differences within the group presenting severe ARDS 470.3 (30.83-1427) vs. the group presenting mild/moderate ARDS 252.1 (0-1253). The difference between the two groups is statistically significant (0.049, p<0.05). The cut-off value of NLR resulted to be 23.64, with an Area Under the Curve (AUC) of 0.653 (95% CI: 0.43-0.88). The best cut-off value of PLR was performed to be 435.14, with an Area Under the Curve (AUC) of 0.645 (95% CI: 0.41-0.88).
Our study showed that NLR and PLR ratios 24 hours in patients with moderate/severe ARDS diagnosis can be a good predictor for severity of the disease. These biomarkers could be used in clinical practice due to their convenience, inexpensiveness, and simplicity of parameters. However, further investigations with larger populations of ARDS patients are necessary to support and validate these current findings.
急性呼吸窘迫综合征（ARDS）是重症监护病房（ICU）死亡的主要原因。中性粒细胞释放的细胞因子和趋化因子会加剧炎症反应，因此必须寻找量化这种病理生理机制影响的方法。中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）是全身炎症的指标，易于获取、价格低廉且参数简单。
我们于2023年3月至2023年6月对入住ICU后24小时内符合柏林ARDS诊断标准的患者进行了一项前瞻性研究。我们纳入了33例患者，分为两组：一组11例重度ARDS患者，另一组22例中度/轻度ARDS患者。该研究评估了人口统计学特征、白细胞、淋巴细胞、中性粒细胞和血小板计数，以及全血细胞计数中的NLR和PLR值，还有严重程度评分（急性生理与慢性健康状况评分系统II [APACHE II]评分和序贯器官衰竭评估 [SOFA]评分）。我们研究了两个主要组（重度和中度/轻度急性呼吸窘迫综合征患者）中NLR和PLR的相关性。
对于NLR比值，两组之间存在统计学显著差异：重度ARDS组为24.29（1.13 - 96），而中度/轻度ARDS组为1.....（此处原文有误，推测应为15.67(1.69 - 49.71)），p = 0.02。对于PLR比值，我们在重度ARDS组中得到了显著差异，为470.3（30.83 - 1427），而轻度/中度ARDS组为252.1（0 - 1253）。两组之间的差异具有统计学显著性（0.049，p < 0.05）。NLR的截断值为23.64，曲线下面积（AUC）为0.653（95%置信区间：0.43 - 0.88）。PLR的最佳截断值为435.14，曲线下面积（AUC）为0.645（95%置信区间：0.41 - 0.88）。
我们的研究表明，在诊断为中度/重度ARDS的患者中，24小时时的NLR和PLR比值可能是疾病严重程度的良好预测指标。由于这些生物标志物方便、价格低廉且参数简单，可用于临床实践。然而，需要对更多ARDS患者进行进一步研究以支持和验证当前这些发现。
