Keywords
Neutrophil/Lymphocyte Index (NLI)
Prognostic marke
How to Cite
Abstract
Introduction: COVID-19 is caused by a beta coronavirus called SARS-CoV-2. About 80 % of the infected population is asymptomatic or paucisymptomatic, and the remaining 20 % can develop severe forms that require more complex services of the health system. Objective: to evaluate the neutrophil-lymphocyte ratio (NLI) as a prognostic biochemical marker for the development of severe COVID-19. Materials and Methods: an observational, retrospective design with inclusion and exclusion criteria was used for this work. The study population consisted of 571 individuals with a laboratory-confirmed diagnosis of COVID- 19, who had an asymptomatic or mild pathology and presented some criteria for poor clinical evolution. Hospitalization, requirement of mechanical respiratory assistance (MRA) and/or death were taken as markers of poor evolution of the patients. Basic laboratory determinations were performed on this population with the evaluation of a complete blood count, where the NLI was calculated by the quotient of the absolute value of neutrophils and lymphocytes. The chosen cut-off point was NLI ≥ 3.1. Results: The descriptive analysis of this population showed that 25.9 % of them required some type of hospitalization, 4.6 % were transferred to the intensive care unit (ICU) requiring MRA, and 5.4 % died. In these three situations, the behavior of the NLI and the personal pathological history of the population were evaluated, and results showed that having an NLI ≥ 3.1 correlates with the following probability of occurrence of events: 4.405 times higher probability of hospitalization; 7.507 times higher probability of being transferred to the ICU and requiring MRA, and 4.982 times higher probability of dying. The results also showed a sensitivity of 92 %; a specificity of 42 %; PPV: 7 %, and NPV: 99 %. Conclusion: The NLI is a good prognostic marker of severe COVID-19 disease, being reproducible, accessible and minimally invasive.
References
Alves-Cunha A, Quispe-Cornejo A, Ávila-Hilari A, Valdivia-Cayoja A, Chino- Mendoza J, Vera-Carrasco O. Breve Historia y fisiopatología del COVID- 19. [Internet] Cuad. Hosp. Clín. 2020; 61(1):130-143.
Cervera-Segura R, Espinosa-Garriga G, Ramos-Casals M, Hernández- Rodríguez J, PrietO-González S, Espígol-Frigolé G, et al. Respuesta Inmunoinflamatoria en la COVID-19. Editorial Medica Panamericana [Internet] Enfermedades Autoinmunes Sistémicas. 6° Edición. 2021:1-22. Disponible en: https://www.medicapanamericana.com/ar/libro/respuesta-inmunoinflamatoria-en-la-covid-19
Gupta A, Madhavan MV, Sehgal K, Nandini N, Mahajan S, Tejasav S et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26:1017–1032.
Vabret N, Britton G, Gruber C, Hegde S, Kim J, Kuksin M, et al. Immunology of COVID-19: Current State of the Science. Immunity 2020; 52(6):910–941.
Trougakos I, Stamatelopoulos K, Terpos E, Tsitsilonis O, Aivalioti E,Paraskevis D. Insights to SARS-CoV-2 life cycle, pathophysiology, and rationalized treatments that target COVID-19 clinical complications. J Biomed Sci. 2021; 28(9):1-18.
Cano F, Gajardo M, Freundlich M. Eje Renina Angiotensina, Enzima Convertidora de Angiotensina 2 y Coronavirus. Rev. Chil. pediatr. 2020; 91(3):330-338.
Sáenz-López J, Sierra-Rodríguez M, García-Salcedo J. Predictores se Mortalidad en Pacientes con COVID-19. iMedPub Journal. 2020;16(2:6):1-3.
Lopez-Diaz J, Gonzalez-Carrillo P, Hernandez-Gonzalez M, Luevanos- Aguilera A. Delta de índice neutrófilo linfocitario como marcador de mortalidad en pacientes con diagnóstico de choque séptico en unidad de cuidados intensivos. Acta Colombiana de Cuidado Intensivo. 2021; 21(2):135–41.
Laboratorio Hospital Comunitario Generalista Evita. Desempeño Analítico de Hematología 04/2021. [Internet]. Disponible en: https://docs.google.com/spreadsheets/d/e/2PACX-1vThZocXLjLN6zFWZ0xtPFPNmCCTaECaDGvHClEdBODYSXJ2wNkXb_nfPHCi09FP6Q/pub?gid=2058970597&single=true&output=pdf
Laboratorio Hospital Comunitario Generalista Evita. Desempeño Analítico de Hematología 05/2021. [Internet]. Disponible en: https://docs.google.com/spreadsheets/d/e/2PACX-1vTRBUB-ShzBl-N4PYztjWnT3ZGb7NDO1OYYtAOFo19_TvdGrgraMlMn5nvTCV7d26g/pub?gid=2058970597&single=true&output=pdf
Laboratorio Hospital Comunitario Generalista Evita. Desempeño Analítico de Hematología 06/2021. [Internet]. Disponible en: https://docs.google.com/spreadsheets/d/e/2PACX-1vT7g50erfGZiLh-E9GQvchUgqCsL5YTxiOaRshLKvro3HyE8hp7j5gt0oDJxoFZfg/pub?gid=2058970597&single=true&output=pdf
SATI Capítulo Bioquímico. COVID-19: Parámetros Bioquímicos de Importancia [Internet]. 2020;vol.2:1-6. Disponible en: https://cofybcf.org.ar/src/img_up/25062020.1.pdf
Dirección de Epidemiologia Ministerio de Salud de La Pampa. Sala de Situación Coronavirus. [Internet]. 2021. Disponible en: https://docs.google.com/document/d/e/2PACX-1vSG2upMSWmhH5aLRAvhPaEhi4qj345LJvbJAW7WfXa2BDxyjtMmNBK7f3rLs05ZL0iI1Szaovv5Doso/pub
IBM. SPSS Manual de Uso [Internet]. 2019:1-12. Disponible en: https://www.ibm.com/docs/en/SSLVMB_26.0.0/pdf/es/IBM_SPSS_Regression.pdf
Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18(206):1-12.
Basbus L, Lapidus M, Martingano I, Puga M, Pollán J. Indice Neutrofilo- Linfocito como factor pronóstico de COVID-19. Medicina (B.Aires). 2020;80(3):31-36.