Hemogram-derived ratios as prognostic markers of ICU admission in COVID-19

BMC Emergency Medicine

Sara Velazquez¹  José María Castellano²  Sara Jimeno³  Rodrigo Madurga⁴  Santiago Ruiz de Aguiar Diaz Obregon⁵  Jesús Rodriguez-Pascual⁶  Paula Sol Ventura Wichner⁷  Alejandro López-Escobar⁸  Juan Ignacio Montero⁹ 

[1] Anaesthesia Department, Hospital Universitario HM Sanchinarro, Madrid, Spain;Anaesthesia Department, Hospital Universitario Santa Cristina, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain;Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain;Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain;Pediatrics Department, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Medical Management, Grupo HM Hospitales, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Oncology Department, HM-CIOCC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Pediatrics Department, Hospital Universitario HM Nens, Barcelona, Spain;Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain;Fundación de Investigación HM Hospitales, Madrid, Spain;Unidad de Investigación Clínica, Fundación Vithas. Grupo Vithas, Madrid, Spain;Pediatrics Department, Hospital Vithas Madrid La Milagrosa, Madrid, Spain;Intensive Care Unit, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain;

关键词: COVID-19;    Hemogram;    Hemogram-derived ratio;    Neutrophil-to-platelet ratio;    Neutrophil-to-lymphocyte ratio;    ICU admission;   

DOI  :  10.1186/s12873-021-00480-w

来源: Springer

【 摘 要 】

BackgroundThe vast impact of COVID-19 call for the identification of clinical parameter that can help predict a torpid evolution. Among these, endothelial injury has been proposed as one of the main pathophysiological mechanisms underlying the disease, promoting a hyperinflammatory and prothrombotic state leading to worse clinical outcomes. Leukocytes and platelets play a key role in inflammation and thrombogenesis, hence the objective of the current study was to study whether neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), the systemic immune-inflammation index (SII) as well as the new parameter neutrophil-to-platelet ratio (NPR), could help identify patients who at risk of admission at Intensive Care Units.MethodsA retrospective observational study was performed at HM Hospitales including electronic health records from 2245 patients admitted due to COVID-19 from March 1 to June 10, 2020. Patients were divided into two groups, admitted at ICU or not.ResultsPatients who were admitted at the ICU had significantly higher values in all hemogram-derived ratios at the moment of hospital admission compared to those who did not need ICU admission. Specifically, we found significant differences in NLR (6.9 [4–11.7] vs 4.1 [2.6–7.6], p <  0.0001), PLR (2 [1.4–3.3] vs 1.9 [1.3–2.9], p = 0.023), NPR (3 [2.1–4.2] vs 2.3 [1.6–3.2], p <  0.0001) and SII (13 [6.5–25.7] vs 9 [4.9–17.5], p <  0.0001) compared to those who did not require ICU admission. After multivariable logistic regression models, NPR was the hemogram-derived ratio with the highest predictive value of ICU admission, (OR 1.11 (95% CI: 0.98–1.22, p = 0.055).ConclusionsSimple, hemogram-derived ratios obtained from early hemogram at hospital admission, especially the novelty NPR, have shown to be useful predictors of risk of ICU admission in patients hospitalized due to COVID-19.

【 授权许可】

CC BY