Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients
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RESEARCH LETTER
Open Access
Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients Aijia Ma†, Jiangli Cheng†, Jing Yang†, Meiling Dong, Xuelian Liao and Yan Kang* Trial registration ChiCTR, ChiCTR2000029758. Registered 12 February 2020 - Retrospectively registered Dear editors: The COVID-19 pandemic has spread rapidly around the world and overwhelmed the supply of intensive care beds and ventilators; judicious ICU resource allocation is still one of the major challenges for clinicians and management [1]. The higher incidence of ARDS is the main reason for the burden of ventilator equipment. Early prediction of the occurrence and aggravation of ARDS in the ICU helps clinicians prepare for respiratory support equipment given the absence of effective treatment strategies. Moreover, early selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with V-V ECMO [2], which is a relatively scarce critical care resource. Therefore, early prediction of moderate-severe ARDS can help clinicians better allocate scarce ICU resources for COVID-19 crisis. Neutrophil-to-lymphocyte ratio (NLR) is a simple biomarker of inflammation that can be measured during routine hematology. Previous studies have exhibited that higher NLR was associated with clinical deterioration and mortality for COVID-19 patients [3]. However, it remains unclear to what extent the significance of NLR would predict the occurrence of ARDS and ICU ventilator requirements for the COVID-19 crisis. * Correspondence: [email protected] † Aijia Ma, Jiangli Chen, and Jing Yang contributed to the work equally and should be regarded as co-first authors. Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
Patients diagnosed with severe COVID-19 from 21 hospitals in Sichuan Province between January 16 and March 15 were included in the analysis (ChiCTR2000029758). The maximum value of NLR, PLR, PCT, and CRP during the first 3 days after being diagnosed as severe COVID-19 was included in the analysis. Severe COVID-19 and ARDS were defined according to previous study [4] and Berlin definition [5], respectively. Multivariate logistic regression analysis and the area under the receiver operating characteristic (ROC) curve were used to analyze the ability of NLR in predicting ARDS. Of totally 81 patients defined as severe COVID-19, 44 were diagnosed as ARDS. The baseline characteristics of the non-ARDS group and ARDS group are listed in Table 1. The area under the ROC curve for ARDS was 0.71, 0.591, 0.494, and 0.625 for NLR, PLR, PCT, and CRP, respectively. We used the median as the cutoff value to divide the patients into two groups. The high NLR group (NLR > 9.8) showed a higher incidence of ARDS (P = 0.005) and higher rate of noninvasive (P = 0.002) and invasive (P = 0.048) mechanical ventilation. Further, we defined moderatesevere ARDS as ARDS patients with oxygenation inde
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