Objective: To explore the predictive value of neutrophil/lymphocyte ratio (NLR) on myocardial injury in severe COVID-19 patients. Methods: In this single-center retrospective cohort study, we collected and analyzed data form 133 severe COVID-19 patients admitted to Renmin Hospital of Wuhan University (Eastern District) from January 30 to February 18, 2020. Patients were divided into myocardial injury group (n=29) and non-myocardial injury group (n=104) according the presence or absence of myocardial injury. The general information of patients was collected by electronic medical record database system. All patients were followed up for 30 days, the organ injury and/or dysfunction were monitored, the in-hospital death was compared between the two groups, and the disease progression was reevaluated and classified at 14 days after initial hospitalization. Logistic regression analysis was performed to identify risk factors of myocardial injury in severe COVID-19 patients. The ROC of NLR was calculated, and the AUC was determined to estimate the optimal cut-off value of NLR for predicting myocardial injury in severe cases of COVID-19. Results: There was statistical significance in age, respiratory frequency, systolic blood pressure, symptoms of dyspnea, previous chronic obstructive pulmonary disease, coronary heart disease history, white blood cells, neutrophils, lymphocytes, platelets, C-reactive protein, platelet counting, aspartate transaminase, albumin, total bilirubin, direct bilirubin, urea, estimated glomerular filtration rate, total cholesterol, low-density lipoprotein cholesterol, D-dimer, CD3+, CD4+, partial pressure of oxygen, partial pressure of CO2, blood oxygen saturation, other organ injury, clinical outcome and prognosis between patients with myocardial injury and without myocardial injury (all P<0.05). Multivariate logistic regression analysis showed that NLR was a risk factor for myocardial injury (OR=1.066，95%CI 1.021-1.111，P=0.033). ROC curve showed that NLR predicting AUC of myocardial injury in severe COVID-19 patients was 0.774 (95%CI 0.694-0.842), the optimal cut-off value of NLR was 5.768, with a sensitivity of 82.8%, and specificity of 69.5%. Conclusion: NLR may be used to predict myocardial injury in severe COVID-19 patients.
目的： 探讨中性粒细胞/淋巴细胞比值（NLR）对新型冠状病毒肺炎（COVID-19）重型患者心肌损伤的预测价值。 方法： 该研究为单中心回顾性队列研究。纳入2020年1月30日至2月18日在武汉大学人民医院东院收治的COVID-19重型患者133例，根据在院期间是否发生心肌损伤分为心肌损伤组（n=29）和非心肌损伤组（n=104）。通过电子病历库系统收集患者的一般临床资料。进行住院期随访，共30 d，随访期间监测患者的器官损伤和/或功能障碍、记录在院死亡情况，住院14 d时行疾病转归再评估分型。采用多因素logistic回归模型分析COVID-19心肌损伤的危险因素，采用受试者工作特征（ROC）曲线评估NLR对心肌损伤的预测价值，并获得最佳截断值。 结果： 心肌损伤组和非心肌损伤组患者的年龄、入院呼吸频率、收缩压，呼吸困难症状、既往慢性阻塞性肺疾病、冠心病病史，白细胞、中性粒细胞、淋巴细胞、血小板、C反应蛋白、降钙素原、门冬氨酸氨基转移酶、白蛋白、总胆红素、直接胆红素、尿素、预估肾小球滤过率、总胆固醇、低密度脂蛋白胆固醇、D-二聚体、CD3+计数、CD4+计数、氧分压、二氧化碳分压、血氧饱和度、其他器官损伤、临床转归及预后差异均有统计学意义（P均<0.05）。多因素logistic回归分析结果显示，NLR是COVID-19重型患者心肌损伤的独立危险因素（OR=1.066，95%CI 1.021~1.111，P=0.033）。ROC曲线结果显示，NLR预测COVID-19重型患者心肌损伤的AUC=0.774，95%CI0.694~0.842，对应的最佳截断值为5.768，敏感度为82.8%，特异度为69.5%。 结论： NLR对COVID-19重型患者心肌损伤具有良好的预测价值。.
Keywords: COVID-19; Heart injury; Neutrophil/lymphocyte ratio.