Rev. chil. anest; 51 (1), 2022
Publication year: 2022
INTRODUCTION:
Patients with COVID-19 can develop respiratory failure requiring treatment with invasive mechanical ventilation (IMV) and death. It is important to have clinical predictors of these outcomes. OBJECTIVES:
To establish the diagnostic accuracy of neutrophil to lymphocyte ratios (NLr) in predicting the need of IMV and survival amongst patients with COVID-19 and to compare this accuracy with other laboratory tests. METHODOLOGY:
Prospective cohort study of hospitalized patients with a SArS-CoV-2 infection confirmed by rT-PCr. Clinical, demographic and laboratory predictors were assessed, including LDH, C-reactive protein, absolute lymphocyte counts, serum ferritin and NLr. Statistical analyses were undertaken using receiver-operator characteristics (ROC) curves, which were in turn compared using the method described by Hanley and McNeal. RESULTS:
One hundred and twelve patients were studied, most were male (60.7%) with a mean age of 63.4 ± 18.3 years. Twenty-two patients required IMV during their stay and 28 died. The NLr showed a good diagnostic accuracy in detecting patients that would require IMV (AUC 0.70, 95% CI 0.57-0.86) or died during the hospitalization (AUC 0.83, 95%CI 0.75-0.91). A cutoff point of 5.5 or higher had an 80.8% sensitivity and 73.1% specificity in detecting patients that died during their stay. CONCLUSIONS. NLR showed favorable diagnostic properties in detecting patients with COVID-19 at risk of adverse outcomes. Its wide availability and low cost are desirable features that might facilitate its implementation in routine clinical practice.
INTRODUCCIÓN:
La infección a SArS-CoV-2 puede generar insuficiencia respiratoria con requerimientos de ventilación mecánica invasiva (VMI). Contar con predictores de este evento es fundamental. OBJETIVOS:
Determinar la capacidad diagnóstica de la relación neutrófilo a linfocito (RNL) para predecir necesidad de VMI o muerte y compararla con otros índices de laboratorio. MÉTODOS:
Cohorte prospectiva de pacientes hospitalizados con diagnóstico confirmado de COVID-19 por PCr. Se evaluaron predictores clínicos, demográficos y de laboratorio, incluyendo LDH, proteína C reactiva, recuento linfocitario, ferritina y la RNL. Los pacientes fueron seguidos hasta el alta hospitalaria. El análisis estadístico se realizó mediante curvas de características de receptor-operador (rOC) que se compararon mediante el método de Hanley y McNeal. RESULTADOS:
Se estudiaron 112 pacientes, 60,7% hombres con media de edad de 63,4 ± 18,3 años. Veintidos ingresaron a ventilación invasiva y 28 fallecieron. La RNL mostró una buena capacidad diagnóstica para detectar pacientes que necesitaron VMI (AUC: 0,70, IC95% 0,57-0,86) o fallecieron durante la hospitalización (AUC: 0,83, IC95% 0,75-0,91). Un punto de corte de 5,5 o superior tuvo una sensibilidad del 80,8% y especificidad del 73,1% para detectar pacientes en riesgo de fallecer por la enfermedad. CONCLUSIONES:
La RNL tiene favorables aptitudes diagnósticas en establecer el riesgo de evolución tórpida en casos de infecciones a SArS-CoV-2. La amplia disponibilidad de la prueba y su bajo costo representan características atractivas para su uso en clínica.