Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Background: Hematological indices can predict disease severity, progression, and death in patients with coronavirus disease-19 (COVID-19). Objectives: To study the predictive value of the dynamic changes (first 48 h after ICU admission) of the following ratios: neutrophil-to-lymphocyte (NLR), platel...

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Main Authors: Emanuel Moisa, Dan Corneci, Silvius Negoita, Cristina Raluca Filimon, Andreea Serbu, Mihai Ionut Negutu, Ioana Marina Grintescu
Format: article
Language:EN
Published: MDPI AG 2021
Subjects:
COVID-19
NLR
systemic inflammation index
dNLR
PLR
MLR
Biology (General)
QH301-705.5
Online Access:https://doaj.org/article/4d25f975b24a4e8ea9d2a8d65f887153
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Summary:Background: Hematological indices can predict disease severity, progression, and death in patients with coronavirus disease-19 (COVID-19). Objectives: To study the predictive value of the dynamic changes (first 48 h after ICU admission) of the following ratios: neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), systemic inflammation index (SII), and derived neutrophil-to-lymphocyte (dNLR) for invasive mechanical ventilation (IMV) need and death in critically ill COVID-19 patients. Methods: Observational, retrospective, and multicentric analysis on 272 patients with severe or critical COVID-19 from two tertiary centers. Hematological indices were adjusted for confounders through multivariate analysis using Cox regression. Results: Patients comprised 186 males and 86 females with no difference across groups (<i>p</i> > 0.05). ΔNLR > 2 had the best independent predictive value for IMV need (HR = 5.05 (95% CI, 3.06–8.33, <i>p</i> < 0.0001)), followed by ΔSII > 340 (HR = 3.56, 95% CI 2.21–5.74, <i>p</i> < 0.0001) and ΔdNLR > 1 (HR = 2.61, 95% CI 1.7–4.01, <i>p</i> < 0.0001). Death was also best predicted by an NLR > 11 (HR = 2.25, 95% CI: 1.31–3.86, <i>p</i> = 0.003) followed by dNLR > 6.93 (HR = 1.89, 95% CI: 1.2–2.98, <i>p</i> = 0.005) and SII > 3700 (HR = 1.68, 95% CI: 1.13–2.49, <i>p</i> = 0.01). Conclusions: Dynamic changes of NLR, SII, and dNLR independently predict IMV need and death in critically ill COVID-19 patients.

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