COVID-19 中 NLR 和 PLR 的预后意义：多队列验证研究

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2024-04-21 DOI:10.1007/s40121-024-00967-6

Marta Colaneri, Camilla Genovese, Federico Fassio, Marta Canuti, Andrea Giacomelli, Anna Lisa Ridolfo, Erika Asperges, Giuseppe Albi, Raffaele Bruno, Spinello Antinori, Antonio Muscatello, Bianca Mariani, Ciro Canetta, Francesco Blasi, Alessandra Bandera, Andrea Gori

{"title":"COVID-19 中 NLR 和 PLR 的预后意义：多队列验证研究","authors":"Marta Colaneri, Camilla Genovese, Federico Fassio, Marta Canuti, Andrea Giacomelli, Anna Lisa Ridolfo, Erika Asperges, Giuseppe Albi, Raffaele Bruno, Spinello Antinori, Antonio Muscatello, Bianca Mariani, Ciro Canetta, Francesco Blasi, Alessandra Bandera, Andrea Gori","doi":"10.1007/s40121-024-00967-6","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this retrospective cohort study, conducted at Milan’s Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes—non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death—in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24–67%, PLR: 40–64%) were inferior to specificity values (NLR: 64–76%, PLR: 55–72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":"38 1","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Significance of NLR and PLR in COVID-19: A Multi-Cohort Validation Study\",\"authors\":\"Marta Colaneri, Camilla Genovese, Federico Fassio, Marta Canuti, Andrea Giacomelli, Anna Lisa Ridolfo, Erika Asperges, Giuseppe Albi, Raffaele Bruno, Spinello Antinori, Antonio Muscatello, Bianca Mariani, Ciro Canetta, Francesco Blasi, Alessandra Bandera, Andrea Gori\",\"doi\":\"10.1007/s40121-024-00967-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Introduction</h3><p>Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>In this retrospective cohort study, conducted at Milan’s Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes—non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death—in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24–67%, PLR: 40–64%) were inferior to specificity values (NLR: 64–76%, PLR: 55–72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.</p>\",\"PeriodicalId\":13592,\"journal\":{\"name\":\"Infectious Diseases and Therapy\",\"volume\":\"38 1\",\"pages\":\"\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infectious Diseases and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s40121-024-00967-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious Diseases and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40121-024-00967-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

摘要

导言最近的研究强调了中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）这两种容易获得的炎症标志物在预测2019年冠状病毒病（COVID-19）患者严重后果方面的预后价值。我们的研究验证了意大利帕维亚IRCCS Policlinico San Matteo（OSM）先前队列中的NLR和PLR临界值，并在来自不同医院的两个新队列中进行了验证。方法在米兰的 Ospedale Luigi Sacco (OLS) 和 IRCCS Ospedale Maggiore Policlinico (OMP) 医院进行的这项回顾性队列研究中，我们评估了 NLR 和 PLR 对入院时患有 COVID-19 的患者的三种主要结果（无创通气 (NIV) 或持续气道正压 (CPAP)）、有创通气 (IV) 和死亡的预测能力。对于每种结果，分别计算了男性和女性队列的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。对男性（NLR 为 7.00、7.29、7.00；PLR 为 239.22、248.00、250.39）和女性（NLR 为 6.36、7.00、6.28；PLR 为 233.00、246.45、241.54）使用了不同的 NLR 和 PLR 临界值。OLS和OMP对NLR和PLR的敏感性值（NLR：24-67%，PLR：40-64%）均低于特异性值（NLR：64-76%，PLR：55-72%）。此外，PPV 值普遍较低（63%），而 PLR 和 NLR 的 NPV 值分别超过 68% 和 72%。最后，与 CPAP/NIV 的 NPV 相比，PLR 和 NLR 在更严重的结果中均表现出更高的 NPV（82%）。高 NPV 强调了它们在识别不太可能出现严重后果的个体方面的作用。这些指标不仅有助于风险分层，还能在紧急情况或资源有限的情况下指导资源分配。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Prognostic Significance of NLR and PLR in COVID-19: A Multi-Cohort Validation Study

Introduction

Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators.

Methods

In this retrospective cohort study, conducted at Milan’s Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes—non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death—in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM.

Results

A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24–67%, PLR: 40–64%) were inferior to specificity values (NLR: 64–76%, PLR: 55–72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV.

Conclusions

Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.