Marcadores inflamatorios como predictores de mortalidad y ventilación mecánica invasiva en pacientes adultos críticos con COVID-19

Abstract

Objectives

Primary outcome: To evaluate the capacity of different indices derived from the complete blood count (neutrophil-lymphocyte index, NLI and platelet-lymphocyte index, PLI), and biochemical markers of inflammation as predictors of mortality in adult critically ill patients with COVID-19. Secondary outcome: To evaluate those indices as predictors of the need for invasive mechanical ventilation (iMV).

Design

Observational, retrospective, single center cohort study.

Setting

Adult ICU.

Patients

Critically ill patients with COVID-19.

Intervention

None.

Variables

Acute Physiology and Chronic Health Evaluation II (APACHE II) score, comorbidities, need for iMV, days on iMV, prone position, status at ICU discharge (alive or deceased), leukocytes and their subpopulations: neutrophils, monocytes and lymphocytes, platelets, and the following inflammatory markers: ferritin, d-dimers, CRP, INL and IPL.

Results

N = 271. N = 155 (57.2%) were men, age 57.3 ± 14.2 years. Overall mortality was 51.3%, while mortality in those who required IMV was 76% (P < .001). The NLR in patients who survived the ICU was 11.9 ± 7.9, vs. 15.3 ± 14.7 in those who died (P = .02). The cut-off value of the NLR to predict the status at ICU discharge was 13.69 (AUC = 0.558; 95% CI: 0.489-0.626; P = .02), while the DD capacity to predict iMV was 1,009 (AUC = 0.588; 95% CI: 0.516-0.661; P = .01). In the multivariate analysis, none of the indices derived from the blood count or the inflammatory biomarkers were independently associated with ICU mortality.

Conclusion

Inflammatory indices such as INL and IPL showed poor predictive value for ICU mortality and iMV in critically ill adult patients with COVID-19.