Hematological ratios in coronavirus disease 2019 patients with and without invasive mechanical ventilation

Abstract

Patients with the most severe form of coronavirus disease 2019 (COVID-19) often require invasive ventilation. Determining the best moment to intubate a COVID-19 patient is complex decision and can result in important consequences for the patient. Therefore, markers that could aid in clinical decision-making such as hematological indices are highly useful. These markers are easy to calculate, do not generate extra costs for the laboratory, and are readily implemented in routine practice. Thus, this study aimed to investigate differences in the ratios calculated from the hemogram between patients with and without the need for invasive mechanical ventilation (IMV) and a control group. This was an observational retrospective analysis of 212 patients with COVID-19 that were hospitalized between April 1, 2020 and March 31, 2021 who were stratified as IMV (n = 129) or did not require invasive mechanical ventilation (NIMV) (n = 83). A control group of 198 healthy individuals was also included. From the first hemogram of each patient performed after admission, the neutrophil-to-lymphocyte ratio (NLR), the derived NLR (d-NLR), the lymphocyte-to-monocyte ratio, the platelet-to-lymphocyte ratio, the neutrophil-to-platelet ratio (NPR), and the systemic immune-inflammation index (SII) were calculated. All hematological ratios exhibited significant differences between the control group and COVID-19 patients. NLR, d-NLR, SII, and NPR were higher in the IMV group than they were in the NIMV group. The hematological indices addressed in this study demonstrated high potential for use as auxiliaries in clinical decision-making regarding the need for IMV.

Systemic inflammation index, disease severity, and mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study design was prospective in three studies ( 50 , 67 , 68 ), unclear in one ( 66 ), and retrospective in the remaining 36 ( 21 , 36 – 49 , 51 – 65 , 69 – 74 ). The clinical endpoints included mortality in 19 studies ( 36 , 37 , 39 , 41 , 43 , 45 , 48 , 49 , 51 , 52 , 55 , 56 , 58 , 60 , 61 , 65 , 66 , 68 , 73 ), and measures of severe disease as follows: disease severity based on existing guidelines in eight ( 42 , 44 , 63 , 64 , 67 , 70 , 72 , 74 ), transfer to the intensive care unit (ICU) in eight ( 38 , 40 , 45 , 50 , 53 , 62 , 68 , 69 ), invasive mechanical ventilation in two ( 46 , 52 ), disease progression in two ( 57 , 71 ), prolonged hospital stay in one ( 21 ), intubation in one ( 37 ), deep vein thrombosis in one ( 54 ), acute pulmonary embolism in one ( 54 ), and acute limb ischemia in one ( 39 ). All studies reported the SII on hospital admission.…”

“…Thirty-nine studies (with 45 patient groups) reported the SII in 19,352 patients (mean age 61 years, 55% males) with a non-severe disease/survivor status and 5,524 patients (mean age 69 years, 60% males) with a severe disease/non-survivor status. Twenty-three studies were conducted in Asia ( 36 , 38 , 40 – 42 , 48 – 51 , 57 , 59 , 62 – 68 , 70 – 74 ), eleven in Europe ( 21 , 39 , 43 , 44 , 47 , 55 , 56 , 58 , 60 , 61 , 69 ), four in America ( 37 , 45 , 46 , 52 ), and one in Africa ( 53 ) ( Table 1 ).…”

“…The risk of bias was low in 29 studies ( 21 , 36 , 37 , 39 – 41 , 43 – 45 , 47 , 49 , 51 – 53 , 55 – 61 , 64 , 65 , 67 , 69 , 71 – 74 ) and high in the remaining ten ( 38 , 42 , 46 , 48 , 50 , 62 , 63 , 66 , 68 , 70 ) ( Supplementary Table 3 ).…”

A meta-analysis on first-trimester blood count parameters—is the neutrophil-to-lymphocyte ratio a potentially novel method for first-trimester preeclampsia screening?

“…NLR is also studied as a predictive biomarker in COVID-19 ( 70 – 72 ): Fernandes et al ( 73 ) found that NLR levels are higher in COVID-19 patients who needed invasive mechanical ventilation than the control group of COVID-19 patients who did not require invasive mechanical ventilation.…”