Abstract
Background: Quick and accurate identification of critically ill patients ensures appropriate and correct use of medical resources. In situations that threaten public health, like pandemics, rapid and effective methods are needed for early disease detection among critically ill patients.
Objective: To determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) of coronavirus disease-19 (COVID-19) patients upon admission to the emergency department (ED) and these patients’ prognosis.
Design and setting: Retrospective cohort study among COVID-19 patients in the ED of a tertiary-level hospital.
Methods: Data on patients’ age, gender, vital signs, chronic diseases, laboratory tests and clinical outcomes were collected from electronic medical records. Receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was used to assess the accuracy of NLR for predicting in-hospital mortality risk and intensive care unit (ICU) requirement. The Youden J index (YJI) was used to determine optimal threshold values.
Results: 1,175 patients were included. Their median age was 63 years (IQR, 48-75). With an NLR cutoff value of 5.14, the sensitivity, specificity, PPV, AUC and YJI for ICU requirement were calculated as 77.87%, 74.08%, 92.4%, 0.811 and 0.5194, respectively. With the same cutoff value, the sensitivity, specificity, AUC and YJI for in-hospital mortality were 77.27%, 75.82%, 0.815 and 0.5309, respectively. In addition, advanced age, leukocytosis, anemia and lymphopenia were found to be associated with poor prognosis.
Conclusion: The NLR, which is a widely available simple parameter, can provide rapid insights regarding early recognition of critical illness and prognosis among COVID-19 patients.
【초록키워드】 COVID-19, public health, Anemia, intensive care, Prognosis, hospital, Gender, risk, ICU, cohort study, Neutrophil-to-lymphocyte ratio, Clinical outcome, lymphopenia, sensitivity, specificity, Coronavirus disease-19, ROC, Accuracy, Patient, Pandemics, age, vital signs, disease detection, electronic medical records, threshold, Admission, Critical, critically ill patients, in-hospital mortality, COVID-19 patients, NLR, Leukocytosis, Analysis, COVID-19 patient, AUC, Laboratory test, receiver operating characteristic, Critically ill patient, Chronic diseases, Medical resources, median age, advanced age, poor prognosis, cutoff value, parameter, effective, was used, collected, addition, was performed, calculated, determine, IQR, PPV, 【제목키워드】 Neutrophil-to-lymphocyte ratio, severity of COVID-19, retrospective cohort study,