The neutrophil-to-lymphocyte ratio in bronchoalveolar lavage fluid could help to personalize corticosteroid therapy in severe COVID-19 pneumonia

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2025-03-06 DOI:10.1016/j.idnow.2025.105054

Nausicaa Beaudequin , Benjamin Glemain , Anne Fajac , Vincent Rothstein , Muriel Fartoukh , Guillaume Voiriot

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Abstract

Objective

To investigate the response to high-dose corticosteroids according to bronchoalveolar neutrophil-to-lymphocyte ratio (BAL-NLR) in critically-ill COVID-19 patients.

Methods

We retrospectively analyzed a single-center cohort of adult COVID-19 patients admitted to the intensive care unit with COVID-19 pneumonia between 2020 and 2022, who had a bronchoalveolar lavage and received systemic corticosteroids. We defined high-dose corticosteroid therapy as the administration of at least 1 mg/kg/day of methylprednisolone.

Results

Among 161 patients, 56 had LOW_BAL-NLR (<0.8), 55 MILD_BAL-NLR (0.8–3.5), and 50 HIGH_BAL-NLR (>3.5). A quarter of patients received high-dose corticosteroid therapy. In the HIGH_BAL-NLR group, those receiving high-dose corticosteroid therapy had a lower (27 % versus 43 %, p = 0.23) 90-day mortality rate than those receiving a standard dose. In the LOW_BAL-NLR group, those receiving high-dose corticosteroid therapy had a higher (31 % versus 12 %, p = 0.12) 90-day mortality rate.

Conclusion

Our results suggest that bronchoalveolar cellular phenotype influences therapeutic response to high-dose corticosteroid therapy.

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支气管肺泡灌洗液中中性粒细胞与淋巴细胞的比值有助于COVID-19重症肺炎患者的个体化皮质类固醇治疗。

目的：观察重症COVID-19患者支气管肺泡中性粒细胞与淋巴细胞比值（BAL-NLR）对大剂量皮质类固醇的反应。方法：回顾性分析2020年至2022年间入住重症监护病房的成人COVID-19肺炎患者的单中心队列，这些患者接受了支气管肺泡灌洗并接受了全身皮质类固醇治疗。我们将高剂量皮质类固醇治疗定义为至少1mg/kg/天的甲基强的松龙。结果：161例患者中，56例为低nlr (BAL-NLR(0.8-3.5))， 50例为高nlr（> -3.5）。四分之一的患者接受了大剂量皮质类固醇治疗。在HIGHBAL-NLR组中，接受高剂量皮质类固醇治疗的患者与接受标准剂量的患者相比，90天死亡率较低（27. %对43. %,p = 0.23）。在LOWBAL-NLR组中，接受高剂量皮质类固醇治疗的患者90天死亡率更高（31 % vs 12 %,p = 0.12）。结论：我们的研究结果表明，支气管肺泡细胞表型影响高剂量皮质类固醇治疗的治疗反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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