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Hemogram-derived ratios as prognostic markers of ICU admission in COVID-19
Sara Velazquez1,2,3,4, Rodrigo Madurga3,5, José María Castellano3,4,6,7
1Anaesthesia Department, Hospital Universitario HM Sanchinarro, Madrid, Spain.
Insights
Predicting severe COVID-19 outcomes is crucial. New hemogram ratios, particularly the neutrophil-to-platelet ratio (NPR), can identify patients at high risk for Intensive Care Unit (ICU) admission.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19's severe impact necessitates identifying predictors of poor outcomes.
- Endothelial injury, inflammation, and prothrombotic states are key pathophysiological mechanisms.
- Leukocytes and platelets are critical in COVID-19-related inflammation and thrombogenesis.
Purpose of the Study:
- To evaluate if neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and neutrophil-to-platelet ratio (NPR) predict ICU admission in COVID-19 patients.
- To identify novel hemogram-derived markers for risk stratification in hospitalized COVID-19 patients.
Main Methods:
- Retrospective observational study of 2245 COVID-19 patients admitted between March 1 and June 10, 2020.
- Patients were categorized based on ICU admission.
- Analysis of hemogram-derived ratios including NLR, PLR, SII, and NPR at hospital admission.
Main Results:
- Patients admitted to the ICU exhibited significantly higher NLR, PLR, NPR, and SII values compared to non-ICU patients.
- NPR demonstrated the highest predictive value for ICU admission among the studied ratios (OR 1.11).
- Significant differences were observed in all tested ratios between ICU and non-ICU groups (p < 0.0001 for NLR, NPR, SII; p = 0.023 for PLR).
Conclusions:
- Simple hemogram-derived ratios, especially NPR, are valuable predictors of ICU admission risk in COVID-19 patients.
- These ratios, obtainable upon hospital admission, aid in early risk stratification.
- The neutrophil-to-platelet ratio (NPR) emerges as a novel and effective marker for predicting severe COVID-19 outcomes requiring intensive care.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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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