单独和联合NLR、TyG指数检测对COVID-19严重程度的预测价值

Prognostic Value of Individual and Combined NLR and TyG Index for Disease Severity in COVID-19 Patients

目的 探讨中性粒细胞与淋巴细胞比值(NLR)联合三酰甘油-葡萄糖指数(TyG指数)与新冠病毒感染(COVID-19)组(n=56)和重度病例组(n=31),比较两组患者的一般情况、慢性病情况、血常规指标、生化指标、NLR和TyG指数。根据NLR和TyG指数的中位数分组后,比较各组之间的结局、呼吸支持方式和病情严重程度。通过Logistics回归探索影响COVID-19严重程度的危险因素。通过受试者工作特征曲线分析NLR、TyG指数和二者联合后预测COVID-19进展为重度的价值。结果 重度病例组的NLR和TyG指数明显高于轻度病例组(NLR:P<0.001,TyG:P=0.028)。根据NLR和TyG指数中位数将研究对象分为4组后,高NLR,高TyG组的COVID-19患者病情更加严重(P<0.001),更容易使用呼吸机辅助呼吸(P=0.037)。在调整多种混杂因素之后,NLR仍是影响COVID-19严重程度的独立影响因素(P=0.001,OR=1.164,95%CI 1.066~1.271)。NLR和TyG指数预测新冠感染严重程度的曲线下面积(AUC)分别为0.759和0.643,两者联合预测的AUC高于单独预测(AUC=0.777)。结论 NLR、TyG指数与新冠感染严重程度关系密切,有望作为发展至重度病例的预测因子,两者联合后的预测价值更高,可能有助于早期制定个体化的治疗方案。

Objective To explore the relationship between NLR combined with the TyG index and the severity and prognosis of COVID-19.Methods The clinical data of 87 COVID-19 patients who were hospitalized and diagnosed in the First Hospital of Shanxi Medical University from December 1,2022 to December 31,2023 were retrospectively analyzed.According to the severity of the disease,these patients were divided into the mild case group(n=56)and severe case group(n=31).The general conditions,chronic disease comorbidities,blood routine indicators,biochemical indicators,NLR and TyG index of these two groups were compared.After grouping according to the median NLR and TyG index,outcomes,respiratory support methods and disease severity were compared.Risk factors influencing COVID-19 severity were identified using logistic regression.AUC values of NLR,TyG index and their combination in predicting the proportion of COVID-19 patients progressing to severe disease were evaluated through the receiver operating characteristic curve(ROC).Results The NLR and TyG index of the severe case group were significantly higher than those of the mild case group(NLR:P<0.001,TyG:P=0.028).When dividing the study subjects into 4 groups based on the median NLR and TyG index,COVID-19 patients in the high NLR and TyG groups had more severe illness(P<0.001)and were more likely to require ventilators for breathing assistance(P=0.037).After adjusting for multiple confounding factors,NLR remained as an independent factor affecting the severity of COVID-19(P=0.001,OR=1.164,95%CI 1.066-1.271).The area under the curve(AUC)for NLR and TyG index in predicting the severity of COVID-19 infection were 0.759 and 0.643,respectively.Combining the two predictions resulted in a higher AUC(AUC=0.777)compared to individual predictions.Conclusion NLR and TyG index are closely related to the severity of COVID-19 infection,and are expected to be used as predictors of severe cases.The combination of these two markers has a higher predictive value and may help to formulate the early-stage individualized treatment plans.