{"title":"入院时中性粒细胞与淋巴细胞比值对COVID-19住院患者胸部x线进展的预测价值","authors":"C. Chantharakhit, A. Inkanuwat, K. Nouchpramool","doi":"10.35755/jmedassocthai.2023.03.13815","DOIUrl":null,"url":null,"abstract":"Objective: Previous studies focused on using the neutrophil-to-lymphocyte ratio (NLR) to monitor COVID-19 patients as an early warning signal of severe COVID-19 infection. Results showed that NLR could also be used as a prognostic factor. In the present study, the role of NLR in predicting chest X-ray (CXR) progression in hospitalized COVID-19 patients was investigated.\n\nMaterials and Methods: The present study was an ambispective observational cohort study that included COVID-19 patients admitted to the isolation ward and COVID-19 intensive care unit between July and September 2021 in Buddhasothorn Hospital, Chachoengsao, Thailand. NLR and demographic findings were analyzed.\n\nResults: Medical details of 564 patients were retrospectively analyzed using 3.24 as the cut-off value of the maximum Youden index to classify a high NLR group and a low NLR group. The estimated cumulative hazard function for CXR progression in the high NLR group was statistically significant, (HR 1.31, 95% CI 1.02 to 1.68, p=0.031). Univariate analysis suggested that high NLR value and three or more clinical risk factors (age 60 years or older, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, stroke, obesity, and immunocompromised) were associated with CXR progression, while multivariate analysis determined high NLR as an independent predictive marker for COVID-19 CXR progression (aOR 1.54, 95% CI 1.06 to 2.23, p=0.022). Using NLR along with pre-existing comorbidity risk factors significantly increased the predictive value for COVID-19 CXR progression (area under the ROC curve 0.565, p=0.017).\n\nConclusion: High NLR at the time of hospitalization was identified as a simple predictor for COVID-19 CXR progression requiring close monitoring.\n\nKeywords: Neutrophil-to-lymphocyte ratio (NLR); COVID-19; Disease progression; Predictive factor; Hospitalization","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"13 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive Value of Neutrophil-to-Lymphocyte Ratio at Admission for Chest X-Ray Progression in Hospitalized COVID-19 Patients\",\"authors\":\"C. Chantharakhit, A. Inkanuwat, K. Nouchpramool\",\"doi\":\"10.35755/jmedassocthai.2023.03.13815\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective: Previous studies focused on using the neutrophil-to-lymphocyte ratio (NLR) to monitor COVID-19 patients as an early warning signal of severe COVID-19 infection. Results showed that NLR could also be used as a prognostic factor. In the present study, the role of NLR in predicting chest X-ray (CXR) progression in hospitalized COVID-19 patients was investigated.\\n\\nMaterials and Methods: The present study was an ambispective observational cohort study that included COVID-19 patients admitted to the isolation ward and COVID-19 intensive care unit between July and September 2021 in Buddhasothorn Hospital, Chachoengsao, Thailand. NLR and demographic findings were analyzed.\\n\\nResults: Medical details of 564 patients were retrospectively analyzed using 3.24 as the cut-off value of the maximum Youden index to classify a high NLR group and a low NLR group. The estimated cumulative hazard function for CXR progression in the high NLR group was statistically significant, (HR 1.31, 95% CI 1.02 to 1.68, p=0.031). Univariate analysis suggested that high NLR value and three or more clinical risk factors (age 60 years or older, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, stroke, obesity, and immunocompromised) were associated with CXR progression, while multivariate analysis determined high NLR as an independent predictive marker for COVID-19 CXR progression (aOR 1.54, 95% CI 1.06 to 2.23, p=0.022). Using NLR along with pre-existing comorbidity risk factors significantly increased the predictive value for COVID-19 CXR progression (area under the ROC curve 0.565, p=0.017).\\n\\nConclusion: High NLR at the time of hospitalization was identified as a simple predictor for COVID-19 CXR progression requiring close monitoring.\\n\\nKeywords: Neutrophil-to-lymphocyte ratio (NLR); COVID-19; Disease progression; Predictive factor; Hospitalization\",\"PeriodicalId\":17486,\"journal\":{\"name\":\"Journal of the Medical Association of Thailand = Chotmaihet thangphaet\",\"volume\":\"13 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-03-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Medical Association of Thailand = Chotmaihet thangphaet\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.35755/jmedassocthai.2023.03.13815\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.35755/jmedassocthai.2023.03.13815","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的:以往的研究主要是利用中性粒细胞与淋巴细胞比值(NLR)监测COVID-19患者,作为COVID-19严重感染的预警信号。结果显示NLR也可作为预后因素。本研究旨在探讨NLR在预测COVID-19住院患者胸部x线(CXR)进展中的作用。材料与方法:本研究是一项双视角观察队列研究,纳入了2021年7月至9月在泰国chachengsao市asothorn医院隔离病房和COVID-19重症监护病房住院的COVID-19患者。对NLR和人口统计学结果进行分析。结果:回顾性分析564例患者的医疗资料,以3.24作为最大约登指数的临界值划分高NLR组和低NLR组。高NLR组CXR进展的累积风险函数估计具有统计学意义(HR 1.31, 95% CI 1.02 ~ 1.68, p=0.031)。单因素分析表明,高NLR值和三个或三个以上临床危险因素(60岁及以上、糖尿病、慢性阻塞性肺病、慢性肾病、肝硬化、卒中、肥胖和免疫功能障碍)与CXR进展相关,而多因素分析确定高NLR是COVID-19 CXR进展的独立预测指标(aOR 1.54, 95% CI 1.06 ~ 2.23, p=0.022)。NLR与既往共病危险因素联合使用可显著提高COVID-19 CXR进展的预测值(ROC曲线下面积0.565,p=0.017)。结论:住院时的高NLR被确定为需要密切监测的COVID-19 CXR进展的简单预测因子。关键词:中性粒细胞与淋巴细胞比值;COVID-19;疾病进展;预测因子;住院治疗
Predictive Value of Neutrophil-to-Lymphocyte Ratio at Admission for Chest X-Ray Progression in Hospitalized COVID-19 Patients
Objective: Previous studies focused on using the neutrophil-to-lymphocyte ratio (NLR) to monitor COVID-19 patients as an early warning signal of severe COVID-19 infection. Results showed that NLR could also be used as a prognostic factor. In the present study, the role of NLR in predicting chest X-ray (CXR) progression in hospitalized COVID-19 patients was investigated.
Materials and Methods: The present study was an ambispective observational cohort study that included COVID-19 patients admitted to the isolation ward and COVID-19 intensive care unit between July and September 2021 in Buddhasothorn Hospital, Chachoengsao, Thailand. NLR and demographic findings were analyzed.
Results: Medical details of 564 patients were retrospectively analyzed using 3.24 as the cut-off value of the maximum Youden index to classify a high NLR group and a low NLR group. The estimated cumulative hazard function for CXR progression in the high NLR group was statistically significant, (HR 1.31, 95% CI 1.02 to 1.68, p=0.031). Univariate analysis suggested that high NLR value and three or more clinical risk factors (age 60 years or older, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, stroke, obesity, and immunocompromised) were associated with CXR progression, while multivariate analysis determined high NLR as an independent predictive marker for COVID-19 CXR progression (aOR 1.54, 95% CI 1.06 to 2.23, p=0.022). Using NLR along with pre-existing comorbidity risk factors significantly increased the predictive value for COVID-19 CXR progression (area under the ROC curve 0.565, p=0.017).
Conclusion: High NLR at the time of hospitalization was identified as a simple predictor for COVID-19 CXR progression requiring close monitoring.
Keywords: Neutrophil-to-lymphocyte ratio (NLR); COVID-19; Disease progression; Predictive factor; Hospitalization