Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage.
中性粒细胞与淋巴细胞比值早期预测 2019 冠状病毒病危重病患者。
- 作者列表："Liu J","Liu Y","Xiang P","Pu L","Xiong H","Li C","Zhang M","Tan J","Xu Y","Song R","Song M","Wang L","Zhang W","Han B","Yang L","Wang X","Zhou G","Zhang T","Li B","Wang Y","Chen Z","Wang X
BACKGROUND:Patients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure. The study aimed to screen the most useful predictive factor for critical illness caused by COVID-19. METHODS:The study prospectively involved 61 patients with COVID-19 infection as a derivation cohort, and 54 patients as a validation cohort. The predictive factor for critical illness was selected using LASSO regression analysis. A nomogram based on non-specific laboratory indicators was built to predict the probability of critical illness. RESULTS:The neutrophil-to-lymphocyte ratio (NLR) was identified as an independent risk factor for critical illness in patients with COVID-19 infection. The NLR had an area under receiver operating characteristic of 0.849 (95% confidence interval [CI], 0.707 to 0.991) in the derivation cohort and 0.867 (95% CI 0.747 to 0.944) in the validation cohort, the calibration curves fitted well, and the decision and clinical impact curves showed that the NLR had high standardized net benefit. In addition, the incidence of critical illness was 9.1% (1/11) for patients aged ≥ 50 and having an NLR < 3.13, and 50% (7/14) patients with age ≥ 50 and NLR ≥ 3.13 were predicted to develop critical illness. Based on the risk stratification of NLR according to age, this study has developed a COVID-19 pneumonia management process. CONCLUSIONS:We found that NLR is a predictive factor for early-stage prediction of patients infected with COVID-19 who are likely to develop critical illness. Patients aged ≥ 50 and having an NLR ≥ 3.13 are predicted to develop critical illness, and they should thus have rapid access to an intensive care unit if necessary.
背景: 因感染 2019 冠状病毒病 (新型冠状病毒肺炎) 而导致危重病的患者，病情迅速进展为急性呼吸衰竭。该研究旨在筛选新型冠状病毒肺炎引起的危重病最有用的预测因子。 方法: 本研究前瞻性纳入 61 例新型冠状病毒肺炎感染患者作为衍生队列，54 例作为验证队列。采用LASSO回归分析选择危重症的预测因素。建立了基于非特异性实验室指标的列线图，用于预测危重症的概率。 结果: 中性粒细胞与淋巴细胞比值 (NLR) 是新型冠状病毒肺炎感染患者发生危重症的独立危险因素。在推导队列中，NLR的接受者操作特征下面积为 0.849 (95% 置信区间 [CI]，0.707 至 0.991)，0.867 (95% CI 0.747 至 0.944) 在验证队列中，校准曲线拟合良好，决策和临床影响曲线显示NLR具有较高的标准化净获益。此外，≥ 50 岁且nlr <9.1% 的患者的危重病发生率为 1/11 (3.13)，50% (7/14) 预测年龄 ≥ 50 岁和nlr ≥ 3.13 的患者发生危重症。基于NLR按年龄的危险分层，本研究制定了肺炎管理流程新型冠状病毒肺炎。 结论: 我们发现NLR是早期预测新型冠状病毒肺炎感染患者可能发生危重病的预测因子。年龄 ≥ 50 岁且nlr ≥ 3.13 的患者预计会发生危重症，因此必要时应快速进入重症监护室。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.