Validation of Neutrophil-to-Lymphocyte Ratio Cut-off Value Associated with High In-Hospital Mortality in COVID-19 Patients.
Validation of Neutrophil-to-Lymphocyte Ratio Cut-off Value Associated with High In-Hospital Mortality in COVID-19 Patients.
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DOI：
10.2147/ijgm.s326666
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发表时间：
2021
影响因子：
2.3
通讯作者：
Yombi JC
中科院分区：
文献类型：
--
作者：
Yildiz H;Castanares-Zapatero D;Pierman G;Pothen L;De Greef J;Aboubakar Nana F;Rodriguez-Villalobos H;Belkhir L;Yombi JC
嗜中性粒细胞与淋巴细胞比率（NLR）可能是严重COVID-19的预测因素。然而，大多数相关研究是回顾性的，最佳NLR截止点尚未确定。我们研究的目的是确定和验证入院时的最佳NLR截止值，该值可以预测COVID-19患者的高住院死亡率。我们审查了2020年3月至4月（衍生队列）和2020年10月至12月（验证队列）期间在我们的专门COVID-19单位因COVID-19肺炎入院的所有患者的医疗档案。299例患者被纳入研究（分别为推导队列198例和验证队列101例）。推导队列中的Youden J统计量确定了入院时NLR性能的最佳截止值，以预测COVID-19住院患者的死亡率。NLR临界值为5.94，敏感性为62%，特异性为64%。在ROC曲线分析中，AUC为0.665 [95%CI 0.530-0.801，p= 0.025]。在验证队列中，NLR的最佳预测截止值为6.4，对应的灵敏度为63%，特异性为64%，AUC为0.766 [95% CI 0.651-0.881，p <0.001]。当在验证队列中应用NLR临界值5.94时，与推导NLR临界值相比，死亡和生存率无显著差异。净重新分类改善（NRI）分析显示，两个NLR临界值之间的结局无显著分类变化（NRI：0.012，p=0.31）。在前瞻性分析中，NLR值为5.94预测因COVID-19肺炎住院的患者入院后的住院死亡率较高。
The neutrophil-to-lymphocyte ratio (NLR) could be a predictive factor of severe COVID-19. However, most relevant studies are retrospective, and the optimal NLR cut-off point has not been determined. The objective of our research was identification and validation of the best NLR cut-off value on admission that could predict high in-hospital mortality in COVID-19 patients. Medical files of all patients admitted for COVID-19 pneumonia in our dedicated COVID-units between March and April 2020 (derivation cohort) and between October and December 2020 (validation cohort) were reviewed. Two hundred ninety-nine patients were included in the study (198 in the derivation and 101 in the validation cohort, respectively). Youden’s J statistic in the derivation cohort determined the optimal cut-off value for the performance of NLR at admission to predict mortality in hospitalized patients with COVID-19. The NLR cut-off value of 5.94 had a sensitivity of 62% and specificity of 64%. In ROC curve analysis, the AUC was 0.665 [95% CI 0.530–0.801, p= 0.025]. In the validation cohort, the best predictive cut-off value of NLR was 6.4, which corresponded to a sensitivity of 63% and a specificity of 64% with AUC 0.766 [95% CI 0.651–0.881, p <0.001]. When the NLR cut-off value of 5.94 was applied in the validation cohort, there was no significant difference in death and survival in comparison with the derivation NLR cut-off. Net reclassification improvement (NRI) analysis showed no significant classification change in outcome between both NLR cut-off values (NRI:0.012, p=0.31). In prospective analysis, an NLR value of 5.94 predicted high in-hospital mortality upon admission in patients hospitalized for COVID-19 pneumonia.