Short-Term Variations in Neutrophil-to-Lymphocyte and Urea-to-Creatinine Ratios Anticipate Intensive Care Unit Admission of COVID-19 Patients in the Emergency Department

Abstract

Background: Timely assessment of COVID-19 severity is crucial for the rapid provision of appropriate treatments. Definitive criteria for the early identification of severe COVID-19 cases that require intensive care unit admission are lacking.Methods: This was a single-center, retrospective case-control study of 95 consecutive adults admitted to the intensive care unit (cases) or a medical ward (controls) for laboratory-confirmed COVID-19. Clinical data were collected and changes in laboratory test results were calculated between presentation at the emergency department and admission. Univariate and multivariable logistic regression was performed to calculate odds ratios for intensive care unit admission according to changes in laboratory variables.Results: Of the 95 adults with COVID-19, 25 were admitted to intensive care and 70 to a medical ward after a median 6 h stay in the emergency department. During this interval, neutrophil counts increased in cases and decreased in controls (median, 934 vs. −295 × 106/L; P = 0.006), while lymphocyte counts decreased in cases and increased in controls (median, −184 vs. 109 × 106/L; P < 0.001). In cases, the neutrophil-to-lymphocyte ratio increased 6-fold and the urea-to-creatinine ratio increased 20-fold during the emergency department stay, but these ratios did not change in controls (P < 0.001 for both comparisons). By multivariable logistic regression, short-term increases in the neutrophil-to-lymphocyte ratio (OR = 1.43; 95% CI, 1.16–1.76) and urea-to-creatinine ratio (OR = 1.72; 95% CI, 1.20–2.66) were independent predictors of intensive care unit admission.Conclusion: Short-time changes in neutrophil-to-lymphocyte ratio and urea-to-creatinine ratio emerged as stand-alone parameters able to identify patients with aggressive disease at an early stage.

Automated AI-Driven CT Quantification of Lung Disease Predicts Adverse Outcomes in Patients Hospitalized for COVID-19 Pneumonia

“…Troponin, creatinine kinase, interleukine-6, platelet count, total and conjugated bilirubin were not uniformly available and thus not included in our risk prediction models. Furthermore, the repetition of biological parameters during the first hours during the stay in the emergency department before admission were not performed or considered, but we know from a study by Solimando et al short-term increases in the neutrophil-to-lymphocyte ratio and urea-to-creatinine ratio were independent predictors of the intensive care unit [ 34 ].…”

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“…Neutrophilia can be explained by the severe Systemic Inflammatory Response Syndrome and the cytokines storm that accompany ICU patients, but also by potential superinfections [ 49 , 51 ]. On the other hand, the decrease of lymphocytes count can find an explanation in the numerous data suggesting tissue sequestration (especially in lungs, lymphoid tissues and GI tract) and destruction in peripheral blood, due to the prevalence of a senescent phenotype of B cells, T cells and natural killer-NK [ 44 , 51 ].…”

The 15-Months Clinical Experience of SARS-CoV-2: A Literature Review of Therapies and Adjuvants

“…Elderly subjects in particular are affected by other comorbidities such as hypertension, cardiovascular diseases, obesity, and diabetes, and subjects with primary or secondary immunodeficiencies have the highest mortality rate [16][17][18][19][20]. Although children tend to experience only mild symptoms, previously healthy young adults have also succumbed to COVID-19 [21][22][23][24]. From the first phases of the COVID-19 pandemic spread, a great amount of information about diagnostic and therapeutic approaches has been reported in the literature, mainly based on preliminary experiences determined by retrospective clinical papers or case reports.…”