Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Emanuel Moisa; Dan Corneci; Silvius Negoita; Cristina Raluca Filimon; Andreea Serbu; Mihai Ionut Negutu; Ioana Marina Grintescu

doi:10.3390/biomedicines9111656

Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Biomedicines. 2021 Nov 10;9(11):1656. doi: 10.3390/biomedicines9111656.

Authors

Emanuel Moisa^{1

2}, Dan Corneci^{1

3}, Silvius Negoita^{1

2}, Cristina Raluca Filimon³, Andreea Serbu³, Mihai Ionut Negutu², Ioana Marina Grintescu^{1

4}

Affiliations

¹ Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.
² Clinic of Anaesthesia and Intensive Care Medicine, Elias Emergency University Hospital, 011461 Bucharest, Romania.
³ Clinic of Anaesthesia and Intensive Care Medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania.
⁴ Clinic of Anaesthesia and Intensive Care Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.

Abstract

Background: Hematological indices can predict disease severity, progression, and death in patients with coronavirus disease-19 (COVID-19).

Objectives: To study the predictive value of the dynamic changes (first 48 h after ICU admission) of the following ratios: neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), systemic inflammation index (SII), and derived neutrophil-to-lymphocyte (dNLR) for invasive mechanical ventilation (IMV) need and death in critically ill COVID-19 patients.

Methods: Observational, retrospective, and multicentric analysis on 272 patients with severe or critical COVID-19 from two tertiary centers. Hematological indices were adjusted for confounders through multivariate analysis using Cox regression.

Results: Patients comprised 186 males and 86 females with no difference across groups (p > 0.05). ΔNLR > 2 had the best independent predictive value for IMV need (HR = 5.05 (95% CI, 3.06-8.33, p < 0.0001)), followed by ΔSII > 340 (HR = 3.56, 95% CI 2.21-5.74, p < 0.0001) and ΔdNLR > 1 (HR = 2.61, 95% CI 1.7-4.01, p < 0.0001). Death was also best predicted by an NLR > 11 (HR = 2.25, 95% CI: 1.31-3.86, p = 0.003) followed by dNLR > 6.93 (HR = 1.89, 95% CI: 1.2-2.98, p = 0.005) and SII > 3700 (HR = 1.68, 95% CI: 1.13-2.49, p = 0.01).

Conclusions: Dynamic changes of NLR, SII, and dNLR independently predict IMV need and death in critically ill COVID-19 patients.

Keywords: COVID-19; ICU; MLR; NLR; PLR; dNLR; mechanical ventilation; sepsis; systemic inflammation index.