Zeba Snjezana, Surbatovic Maja, Udovicic Ivo, Stanojevic Ivan, Vojvodic Danilo, Rondovic Goran, Mladenovic Katarina, Abazovic Tanja, Hasanovic Almina, Ilic Aleksandra N, Abazovic Dzihan, Khan Wasim, Djordjevic Dragan
Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia.
Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Belgrade, Serbia.
J Inflamm Res. 2025 Jan 3;18:73-90. doi: 10.2147/JIR.S488972. eCollection 2025.
The aim of the retrospective, single-center study was to assess the prognostic value of immune cell-based and albumin-based ratios regarding lethal outcome in critically ill COVID-19 patients.
We analyzed 612 adult critically ill COVID-19 patients admitted to the intensive care unit (ICU) between April 2020 and November 2022. Blood measurement on admission to the ICU encompassed complete blood count (CBC), IL-6, C-reactive protein (CRP), albumin, lactate, lactate dehydrogenase (LDH), serum bicarbonate, arterial base deficit/excess (BD/E), and D-dimer. All the measured and calculated parameters were compared between survivors and nonsurvivors, with the outcome measure being hospital mortality.
Immune cell-based ratios [NLR - Neutrophil-to-Lymphocyte Ratio, MLR - Monocyte-to-Lymphocyte Ratio, PLR - Platelet-to-Lymphocyte Ratio, MPV - Mean Platelet Volume, MPV/PC - Mean Platelet Volume-to-Platelet Count Ratio, Derived (d-)NLR ratio - neutrophil count divided by the result of white blood cell (WBC) count - neutrophil count), N/LP - Neutrophil count x 100/Lymphocyte count x Platelet count, CLR - C-reactive protein (CRP)-to-Lymphocyte Ratio, CPR - CRP-to-Platelet Ratio, LLR - Lactate dehydrogenase (LDH)-to-Lymphocyte Ratio, Systemic Immune Inflammation Index (SII) - platelet x neutrophil/lymphocyte count, Systemic Inflammation Response Index (SIRI) - neutrophil x monocyte/lymphocyte count] were investigated. White blood cell and neutrophil counts were significantly higher, while lymphocyte and platelet counts were significantly lower in nonsurvivors. MPV, MPV/PC, NLR, d-NLR, MLR, N/LP, CRP, LDH, CPR, CLR, LLR, SII, and SIRI values were significantly higher in nonsurvivors. Monocyte count and PLR values did not differ significantly between groups. Albumin-based ratios included CRP-to-Albumin Ratio (CAR), Lactate-to-Albumin Ratio (LAR) and LDH-to-Albumin Ratio (LDH/ALB). All values were significantly higher in nonsurvivors.
The only independent predictor of lethal outcomes at ICU admission is the albumin-based LDH/ALB ratio. Most of the other parameters were moderate, although highly significant predictors of mortality in critically ill COVID-19 patients.
这项回顾性单中心研究的目的是评估基于免疫细胞和基于白蛋白的比值对危重症COVID-19患者致死结局的预后价值。
我们分析了2020年4月至2022年11月期间入住重症监护病房（ICU）的612例成年危重症COVID-19患者。入住ICU时的血液检测包括全血细胞计数（CBC）、白细胞介素-6（IL-6）、C反应蛋白（CRP）、白蛋白、乳酸、乳酸脱氢酶（LDH）、血清碳酸氢盐、动脉碱缺失/过剩（BD/E）和D-二聚体。比较了幸存者和非幸存者之间所有测量和计算的参数，结局指标为医院死亡率。
研究了基于免疫细胞的比值[中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积（MPV）、平均血小板体积与血小板计数比值（MPV/PC）、衍生（d-）NLR比值 - 中性粒细胞计数除以白细胞（WBC）计数 - 中性粒细胞计数的结果）、中性粒细胞计数×100/淋巴细胞计数×血小板计数（N/LP）、C反应蛋白（CRP）与淋巴细胞比值（CLR）、CRP与血小板比值（CPR）、乳酸脱氢酶（LDH）与淋巴细胞比值（LLR）、全身免疫炎症指数（SII） - 血小板×中性粒细胞/淋巴细胞计数、全身炎症反应指数（SIRI） - 中性粒细胞×单核细胞/淋巴细胞计数]。非幸存者的白细胞和中性粒细胞计数显著更高，而淋巴细胞和血小板计数显著更低。非幸存者的MPV、MPV/PC、NLR、d-NLR、MLR、N/LP、CRP、LDH、CPR、CLR、LLR、SII和SIRI值显著更高。两组之间单核细胞计数和PLR值无显著差异。基于白蛋白的比值包括CRP与白蛋白比值（CAR）、乳酸与白蛋白比值（LAR）和LDH与白蛋白比值（LDH/ALB）。非幸存者的所有值均显著更高。
入住ICU时致死结局的唯一独立预测因素是基于白蛋白的LDH/ALB比值。尽管大多数其他参数是危重症COVID-19患者死亡率的高度显著预测因素，但大多为中等程度。
