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

BMC Emergency Medicine - Tập 21 - Trang 1-9 - 2021
Sara Velazquez1,2,3,4, Rodrigo Madurga3,5, José María Castellano3,4,6,7, Jesús Rodriguez-Pascual3,8, Santiago Ruiz de Aguiar Diaz Obregon3,9, Sara Jimeno3,4,10, Juan Ignacio Montero11, Paula Sol Ventura Wichner3,12,13, Alejandro López-Escobar3,14,15
1Anaesthesia Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
2Anaesthesia Department, Hospital Universitario Santa Cristina, Madrid, Spain
3Fundación de Investigación HM Hospitales, Madrid, Spain
4Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain
5Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
6 Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
7Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
8 Oncology Department, HM-CIOCC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain
9Medical Management, Grupo HM Hospitales, Madrid, Spain
10Pediatrics Department, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain
11Intensive Care Unit, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain
12Pediatrics Department, Hospital Universitario HM Nens, Barcelona, Spain
13Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
14Unidad de Investigación Clínica, Fundación Vithas. Grupo Vithas, Madrid, Spain
15Pediatrics Department, Hospital Vithas Madrid La Milagrosa, Madrid, Spain

Tóm tắt

The 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. A 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. Patients 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). Simple, 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.

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