支气管肺泡灌洗 fluid 中的中性粒细胞与淋巴细胞比值有助于在重症 COVID-19 肺炎中实现皮质类固醇治疗的个体化。

The neutrophil-to-lymphocyte ratio in bronchoalveolar lavage fluid could help to personalize corticosteroid therapy in severe COVID-19 pneumonia.

作者信息

Beaudequin Nausicaa, Glemain Benjamin, Fajac Anne, Rothstein Vincent, Fartoukh Muriel, Voiriot Guillaume

机构信息

Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Médecine Intensive Réanimation, Hôpital Tenon, Paris, France.

Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Département de santé publique, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, INSERM, Institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France.

出版信息

Infect Dis Now. 2025 May;55(3):105054. doi: 10.1016/j.idnow.2025.105054. Epub 2025 Mar 6.

DOI:10.1016/j.idnow.2025.105054

PMID:40057193

Abstract

OBJECTIVE

To investigate the response to high-dose corticosteroids according to bronchoalveolar neutrophil-to-lymphocyte ratio (BAL-NLR) in critically-ill COVID-19 patients.

METHODS

We retrospectively analyzed a single-center cohort of adult COVID-19 patients admitted to the intensive care unit with COVID-19 pneumonia between 2020 and 2022, who had a bronchoalveolar lavage and received systemic corticosteroids. We defined high-dose corticosteroid therapy as the administration of at least 1mg/kg/day of methylprednisolone.

RESULTS

Among 161 patients, 56 had LOW (<0.8), 55 MILD (0.8-3.5), and 50 HIGH (>3.5). A quarter of patients received high-dose corticosteroid therapy. In the HIGH group, those receiving high-dose corticosteroid therapy had a lower (27 % versus 43 %, p = 0.23) 90-day mortality rate than those receiving a standard dose. In the LOW group, those receiving high-dose corticosteroid therapy had a higher (31 % versus 12 %, p = 0.12) 90-day mortality rate.

CONCLUSION

Our results suggest that bronchoalveolar cellular phenotype influences therapeutic response to high-dose corticosteroid therapy.

摘要

目的

根据支气管肺泡中性粒细胞与淋巴细胞比值（BAL-NLR），研究重症新型冠状病毒肺炎（COVID-19）患者对大剂量糖皮质激素的反应。

方法

我们回顾性分析了2020年至2022年间入住重症监护病房的成年COVID-19肺炎患者的单中心队列，这些患者接受了支气管肺泡灌洗并接受了全身糖皮质激素治疗。我们将大剂量糖皮质激素治疗定义为给予至少1mg/kg/天的甲泼尼龙。

结果

161例患者中，56例为低水平（<0.8），55例为中等水平（0.8 - 3.5），50例为高水平（>3.5）。四分之一的患者接受了大剂量糖皮质激素治疗。在高水平组中，接受大剂量糖皮质激素治疗的患者90天死亡率低于接受标准剂量治疗的患者（27%对43%，p = 0.23）。在低水平组中，接受大剂量糖皮质激素治疗的患者90天死亡率高于接受标准剂量治疗的患者（31%对12%，p = 0.12）。