PDF(Pubmed)
Abstract：
BACKGROUND: Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators.
METHODS: In this retrospective cohort study, conducted at Milan\'s Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes-non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death-in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM.
RESULTS: A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24-67%, PLR: 40-64%) were inferior to specificity values (NLR: 64-76%, PLR: 55-72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV.
CONCLUSIONS: Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.
METHODS: In this retrospective cohort study, conducted at Milan\'s Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes-non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death-in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM.
RESULTS: A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24-67%, PLR: 40-64%) were inferior to specificity values (NLR: 64-76%, PLR: 55-72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV.
CONCLUSIONS: Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.
摘要：
背景：最近的研究强调了容易获得的炎症标志物的预后价值，中性粒细胞与淋巴细胞比率（NLR），和血小板淋巴细胞比（PLR）预测2019年冠状病毒病（COVID-19）患者的严重预后。我们的研究验证了来自Pavia的IRCCSPoliclinicoSanMatteo（OSM）的先前队列的NLR和PLR截止值，意大利,来自不同医院的两个新队列。这旨在增强这些预后指标的普适性。
方法：在这项回顾性队列研究中，在米兰的OspedaleLuigiSacco（OLS）和IRCCSOspedaleMaggiorePoliclinico（OMP）医院进行，我们评估了NLR和PLR对三种主要结局的预测能力-无创通气（NIV）或持续气道正压通气（CPAP）的使用，有创通气（IV），和COVID-19患者入院时死亡。对于每个结果，灵敏度,特异性，阳性预测值(PPV)，分别计算男性和女性队列的阴性预测值（NPV）。男性（NLR为7.00，7.29，7.00，PLR为239.22，248.00，250.39）和女性（NLR为6.36，7.00，6.28；PLR为233.00，246.45，241.54）使用了不同的NLR和PLR临界值，从OSM的第一个队列中检索。
结果：本研究共纳入3599例患者，1842年来自OLS，1757年来自OMP。NLR和PLR的OLS和OMP灵敏度值（NLR：24-67%，PLR：40-64%）低于特异性值（NLR：64-76%，PLR：55-72%）。此外,PPV总体上保持较低（<63%），而NPV始终超过68%的PLR和72%的NLR。最后,与CPAP/NIV的NPV相比,PLR和NLR在更严重的结局方面始终表现出更高的NPV(>82%).
结论：不同患者人群的一致发现验证了NLR和PLR截止值的可靠性和适用性。高NPV强调他们在识别不太可能经历严重结果的个体中的作用。这些标记不仅有助于风险分层，而且还指导紧急情况或资源有限情况下的资源分配。
方法：在这项回顾性队列研究中，在米兰的OspedaleLuigiSacco（OLS）和IRCCSOspedaleMaggiorePoliclinico（OMP）医院进行，我们评估了NLR和PLR对三种主要结局的预测能力-无创通气（NIV）或持续气道正压通气（CPAP）的使用，有创通气（IV），和COVID-19患者入院时死亡。对于每个结果，灵敏度,特异性，阳性预测值(PPV)，分别计算男性和女性队列的阴性预测值（NPV）。男性（NLR为7.00，7.29，7.00，PLR为239.22，248.00，250.39）和女性（NLR为6.36，7.00，6.28；PLR为233.00，246.45，241.54）使用了不同的NLR和PLR临界值，从OSM的第一个队列中检索。
结果：本研究共纳入3599例患者，1842年来自OLS，1757年来自OMP。NLR和PLR的OLS和OMP灵敏度值（NLR：24-67%，PLR：40-64%）低于特异性值（NLR：64-76%，PLR：55-72%）。此外,PPV总体上保持较低（<63%），而NPV始终超过68%的PLR和72%的NLR。最后,与CPAP/NIV的NPV相比,PLR和NLR在更严重的结局方面始终表现出更高的NPV(>82%).
结论：不同患者人群的一致发现验证了NLR和PLR截止值的可靠性和适用性。高NPV强调他们在识别不太可能经历严重结果的个体中的作用。这些标记不仅有助于风险分层，而且还指导紧急情况或资源有限情况下的资源分配。
