Abstract
There is a deep need for mortality predictors that allow clinicians to quickly triage patients with severe coronavirus disease 2019 (Covid-19) into intensive care units at the time of hospital admission. Thus, we examined the efficacy of the lymphocyte-to-neutrophil ratio (LNR) and neutrophil-to-monocyte ratio (NMR) as predictors of in-hospital death at admission in patients with severe Covid-19. A total of 54 Mexican adult patients with Covid-19 that met hospitalization criteria were retrospectively enrolled, followed-up daily until hospital discharge or death, and then assigned to survival or non-survival groups. Clinical, demographic, and laboratory parameters were recorded at admission. A total of 20 patients with severe Covid-19 died, and 75% of them were men older than 62.90 ± 14.18 years on average. Type 2 diabetes, hypertension, and coronary heart disease were more prevalent in non-survivors. As compared to survivors, LNR was significantly fourfold decreased while NMR was twofold increased. LNR ≤ 0.088 predicted in-hospital mortality with a sensitivity of 85.00% and a specificity of 74.19%. NMR ≥ 17.75 was a better independent risk factor for mortality with a sensitivity of 89.47% and a specificity of 80.00%. This study demonstrates for the first time that NMR and LNR are accurate predictors of in-hospital mortality at admission in patients with severe Covid-19.
Highlights
The outbreak of coronavirus disease 2019 (Covid-19) is an ongoing global pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that has affected the lives of millions of people worldwide [1]
Patients with severe Covid-19 and procalcitonin values greater than 0.1 ng/mL exhibit a 50% decrease in the survival probability after 12 days of hospitalization (Figure 4H). Taking these results into account, we propose a new triage based on the use of neutrophil-to-monocyte ratio (NMR) and lymphocyte-to-neutrophil ratio (LNR) to assist clinicians to estimate in-hospital death risk in critically ill patients with Covid-19, with the aim of quickly admitting them into intensive care units and reducing the number of fatalities related to this disease (Figure 5)
Taking these results into account, we propose a new triage based on the use of NMR and LNR to assist clinicians to estimate in-hospital death risk in critically ill patients with Covid-19, with the Maiimcrooorfgaqnuisimcsk2ly02a0,d8m, 1i5t6t0ing them into intensive care units and reducing the number of fatalities r1e2laotfe1d7 to this disease (Figure 5)
Summary
The outbreak of coronavirus disease 2019 (Covid-19) is an ongoing global pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that has affected the lives of millions of people worldwide [1]. More than 85% of patients with Covid-19 show a self-limiting illness with symptoms such as mild fever, dry cough, and fatigue, some patients develop severe pneumonia that can progress to acute respiratory distress syndrome, multiple organ failure, and death [2]. Mortality rates directly attributed to severe Covid-19 ranges from 3% in countries like China to 10% in countries like Spain [3,4]. It is of great importance to develop novel tools that help us to estimate the mortality risk at admission in patients with severe Covid-19 that need hospitalization, with the aim of quickly triaging them into intensive care units
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