Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage

Jingyuan Liu,Xianbo Wang,Yanli Xu,Xiaojing Wang,Lin Wang,Ben Li,Yanbin Wang,Jianbo Tan,Chuansheng Li,Yao Liu,Wei Zhang,Rui Song,Ming Zhang,Lin Pu,Pan Xiang,Haofeng Xiong,Ting Zhang,Guiqin Zhou,Li Yang,Meihua Song,Bing Han,Zhihai Chen

doi:10.1186/s12967-020-02374-0

Abstract

BackgroundPatients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure. The study aimed to screen the most useful predictive factor for critical illness caused by COVID-19.MethodsThe study prospectively involved 61 patients with COVID-19 infection as a derivation cohort, and 54 patients as a validation cohort. The predictive factor for critical illness was selected using LASSO regression analysis. A nomogram based on non-specific laboratory indicators was built to predict the probability of critical illness.ResultsThe neutrophil-to-lymphocyte ratio (NLR) was identified as an independent risk factor for critical illness in patients with COVID-19 infection. The NLR had an area under receiver operating characteristic of 0.849 (95% confidence interval [CI], 0.707 to 0.991) in the derivation cohort and 0.867 (95% CI 0.747 to 0.944) in the validation cohort, the calibration curves fitted well, and the decision and clinical impact curves showed that the NLR had high standardized net benefit. In addition, the incidence of critical illness was 9.1% (1/11) for patients aged ≥ 50 and having an NLR < 3.13, and 50% (7/14) patients with age ≥ 50 and NLR ≥ 3.13 were predicted to develop critical illness. Based on the risk stratification of NLR according to age, this study has developed a COVID-19 pneumonia management process.ConclusionsWe found that NLR is a predictive factor for early-stage prediction of patients infected with COVID-19 who are likely to develop critical illness. Patients aged ≥ 50 and having an NLR ≥ 3.13 are predicted to develop critical illness, and they should thus have rapid access to an intensive care unit if necessary.

Highlights

Patients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure
None of the 115 patients had a history of Huanan seafood market exposure in Wuhan. 44 of patients (72.1%) with pneumonia caused by COVID-19 infection in the derivation cohort were Wuhan citizens or visited Wuhan recently, but 44 of patients (81.5%) in the validation cohort had not left Beijing recently, but had a close exposure history with COVID-19
The three factors mentioned above were included in the multivariate COX regression analysis, and the results indicated that age and neutrophil-to-lymphocyte ratio (NLR) are prognostic factors for critical illness of COVID-19 infection

Summary

Introduction

Patients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure. The study aimed to screen the most useful predictive factor for critical illness caused by COVID-19. Coronavirus is a large virus family, members of which are known to cause common cold and serious illnesses, such as the Middle East respiratory syndrome and severe acute respiratory syndrome [1,2,3,4]. In cases of critical illness, patients progressed rapidly to acute respiratory failure, acute respiratory distress syndrome, metabolic acidosis, coagulopathy, and septic shock. Identification of risk factors for critical illness facilitated appropriate provision of supportive care and rapid access to the intensive care unit (ICU) when required. Early prognosis prediction would help reduce mortality and alleviate the shortage of medical resources

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Discussion

Conclusion