Fors Martha, Ballaz Santiago J
Escuela de Medicina, Universidad de las Américas-UDLA, Quito, Ecuador.
Facultad de Ciencias de la Salud, Universidad Espíritu Santo, Samborondón, Ecuador.
Future Sci OA. 2024 Dec;10(1):2432180. doi: 10.1080/20565623.2024.2432180. Epub 2024 Nov 22.
AIMS/BACKGROUND: We looked at novel hematological composites like the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, red cell distribution width-to-lymphocyte ratio, red cell distribution width-to-platelet ratio, leukocyte-to-C reactive protein ratio, and lymphocyte-to-C reactive protein ratio as explanatory variables for COVID-19 patients´ hospital length of stay (LoS).
The association of hematological indices with LoS was analyzed on 2930 COVID-19 patients using the univariate and multivariable Cox proportional hazards regression models with enter method. The Kaplan-Meier survival estimates were applied to LoS.
The survivors´ mean LoS was 7.8 ± 24.0 days, but the deaths´ mean LoS was 38.6 ± 41.9 days (W = 31338, p < 0.01). Every hematological scores representative of the inflammatory status was significantly correlated in the univariate analysis with a prolonged LoS (p < 0.001). In the multivariate analysis, it was discovered that just the monocyte-to-lymphocyte and lymphocyte-to-C reactive protein ratios had not achieved statistical significance. However, most systemic inflammation measures showed hazards ratios close to one. One exemption was the red cell distribution width-to-platelet ratio (RPR) index, which can increase the probability of a longer hospital stay by up to ten times (HR(IC95%) = 0.092(0.03-0.29); p < 0.001).
The most effective biomarker to identify COVID-19 patients at high risk for extended hospital stay was RPR.
Determining hospital Length of Stay (LoS) is vital for resource management, especially for future COVID-19 outbreaks.Previous studies have primarily focused on sociodemographic and clinical attributes, along with resource availability, but have not accounted for other factors like routine laboratory tests, which can significantly impact LoS predictions.This study examines novel hematology scores as predictors of LoS, emphasizing their importance in resource-limited settings like Ecuador.This retrospective cohort study analyzed 2,930 COVID-19 patients admitted to Hospital IESS Quito Sur in Ecuador focusing on confirmed cases with complete blood count (CBC) values to assess LoS.The study explored various hematological ratios, such as the neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width-to-lymphocyte ratio (RLR), as potential predictors of LoS and in-hospital outcomes for COVID-19 patients, using a combination of univariate and multivariable Cox proportional hazards regression models.Kaplan-Meier survival estimates and log-rank tests were used to analyze survival and discharge probabilities over time, highlighting sex-dependent effects and the significant association between selected hematological indices and patient outcomes.The mean LoS for survivors was significantly shorter compared to those who died (p < 0.001), indicating that longer hospitalization was associated with higher mortality risk.Women had a shorter average LoS (with lower mortality risk (p < 0.001), suggesting an asymmetrical hospitalization pattern based on sex.While most hematological markers had minimal clinical relevance for LoS, the red cell distribution width-to-platelet ratio (RPR) stood out, increasing the likelihood of a longer hospital stay by up to tenfold, making it a critical factor in predicting prolonged hospitalization.Men had longer hospital stays and higher mortality rates than women, likely due to differing inflammatory responses, though hyperinflammation markers like NLR, PLR, and Leu-CPR had minimal clinical impact.RPR had the strongest link to longer hospital stays, indicating a higher risk of extended hospitalization in severe COVID-19 cases.Elevated RPR is tied to oxidative stress and coagulation issues, suggesting early identification could help reduce prolonged stays and complications.Research generally points to clinical complications from COVID-19 as the main factor behind prolonged hospitalizations, underlining the importance of early identification and management of these issues.
目的/背景：我们研究了新型血液学复合指标，如中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、单核细胞与淋巴细胞比值、红细胞分布宽度与淋巴细胞比值、红细胞分布宽度与血小板比值、白细胞与C反应蛋白比值以及淋巴细胞与C反应蛋白比值，将其作为新冠病毒疾病（COVID - 19）患者住院时长（LoS）的解释变量。
采用单变量和多变量Cox比例风险回归模型及逐步回归法，对2930例COVID - 19患者的血液学指标与住院时长的相关性进行分析。将Kaplan - Meier生存估计应用于住院时长。
幸存者的平均住院时长为7.8±24.0天，而死亡者的平均住院时长为38.6±41.9天（W = 31338，p < 0.01）。在单变量分析中，每一个代表炎症状态的血液学评分均与延长的住院时长显著相关（p < 0.001）。在多变量分析中，发现只有单核细胞与淋巴细胞比值以及淋巴细胞与C反应蛋白比值未达到统计学意义。然而，大多数全身炎症指标的风险比接近1。一个例外是红细胞分布宽度与血小板比值（RPR）指数，它可使住院时间延长的概率增加至十倍（风险比（95%置信区间）= 0.092(0.03 - 0.29)；p < 0.001）。
识别COVID - 19患者住院时间延长高危风险的最有效生物标志物是RPR。
确定住院时长（LoS）对于资源管理至关重要，尤其是对于未来的COVID - 19疫情。以往的研究主要集中在社会人口统计学和临床特征以及资源可用性，但未考虑常规实验室检查等其他因素，而这些因素可能会显著影响LoS预测。本研究将新型血液学评分作为LoS的预测指标进行研究，强调了它们在厄瓜多尔等资源有限环境中的重要性。这项回顾性队列研究分析了厄瓜多尔基多南部IESS医院收治的2930例COVID - 19患者，重点关注有全血细胞计数（CBC）值的确诊病例以评估住院时长。该研究探索了各种血液学比值，如中性粒细胞与淋巴细胞比值（NLR）和红细胞分布宽度与淋巴细胞比值（RLR），作为COVID - 19患者住院时长和院内结局的潜在预测指标，采用了单变量和多变量Cox比例风险回归模型相结合的方法。使用Kaplan - Meier生存估计和对数秩检验来分析随时间的生存和出院概率，突出了性别依赖性效应以及所选血液学指标与患者结局之间的显著关联。幸存者的平均住院时长明显短于死亡者（p < 0.001），这表明住院时间延长与更高的死亡风险相关。女性的平均住院时长较短（死亡风险较低（p < 0.001）），表明基于性别的住院模式不对称。虽然大多数血液学标志物对住院时长的临床相关性最小，但红细胞分布宽度与血小板比值（RPR）脱颖而出，使住院时间延长的可能性增加至十倍，使其成为预测住院时间延长的关键因素。男性的住院时间更长，死亡率更高，可能是由于炎症反应不同，尽管NLR、PLR和Leu - CPR等高炎症标志物的临床影响最小。RPR与住院时间延长的联系最为紧密，表明重症COVID - 19病例住院时间延长的风险更高。RPR升高与氧化应激和凝血问题有关，这表明早期识别有助于减少住院时间延长和并发症。研究一般指出COVID - 19的临床并发症是住院时间延长的主要因素，强调了早期识别和管理这些问题的重要性。
