外周血中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对新型冠状病毒肺炎预后的预测价值

The Prognostic Value of Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio in 2019-Novel Coronavirus Disease

目的:探讨外周血中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)与新型冠状病毒肺炎(COVID-19)患者预后的相关性及其临床意义。方法回顾性分析了2020年1月24日—2020年4月25日确诊的183例COVID-19患者的临床资料及实验室检查结果,比较了重型与非重型患者的数据差异,并评估NLR、PLR等各项指标对患者住院时间的影响。结果入组患者中非重型患者143例,重型患者40例。重型患者入院时的CRP、白细胞计数、中性粒细胞计数、NLR、PLR均明显高于非重型患者,而淋巴细胞计数则明显低于非重型患者。单因素Cox回归分析显示年龄小于60岁患者住院时间较短(HR=0.583,95%CI:0.391~0.870;P=0.008);入院时淋巴细胞计数低(HR=4.129,95%CI:1.979~8.617;P<0.001)及NLR高(HR=1.601,95%CI:1.064~2.409;P<0.001)与COVID-19住院时间长、预后差相关。多因素Cox回归分析显示:入院时淋巴细胞计数(HR=6.004,95%CI:2.167~16.636;P=0.001)及NLR(HR=1.397,95%CI:1.092~1.853;P=0.037)是COVID-19住院时长的影响因素。结论NLR、PLR对COVID-19的病情严重程度具有一定的提示作用;NLR、淋巴细胞计数可能是COVID-19的重要预后预测指标,NLR越高、淋巴细胞计数越低,患者住院时间越长,对临床具有指导意义。

Objective To evaluate the predictive value and clinical significance of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in 2019-novel coronavirus disease.Methods The clinical characteristics and laboratory data of 183 COVID-19 cases diagnosed were retrospectively analyzed from January 24,2020 to April 25,2020,the clinical variations between severe and non-severe patients were compared,and the predictive value of NLR,PLR and other factors for length of hospitalization was evaluated.Results There were 40 severe cases and 143 non-severe cases involved in the study.CRP,WBC,NEU,NLR,PLR were significantly higher and LYM was lower in severe cases compared with non-severe cases.In univariate analysis,patients aged younger than 60 had shorter length of hospitalization(HR=0.583,95%CI:0.391-0.870,P=0.008),while lower LYM(HR=4.129,95%CI:1.979-8.617,P<0.001)and higher NLR(HR=1.601,95%CI:1.064-2.409,P<0.001)were associated with longer length of hospitalization.Multivariate analyses demonstrated that LYM(HR=6.004,95%CI:2.167-16.636,P=0.001)and NLR(HR=1.397,95%CI:1.092-1.853,P=0.037)were independent factors for predicating length of hospitalization.Conclusion NLR and PLR were closely related to the severity of COVID-19.Elevated NLR and lower LYM predicted long-term hospitalization,and they may be independent predictive factors for COVID-19.