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Delta del índice neutrófilo linfocito y mortalidad en infección COVID-19 / Delta of neutrophil lymphocyte index and mortality in covid-19 disease
Resumen
Resumen
Introducción: el síndrome de dificultad respiratoria aguda, por SARS-CoV-2, es un problema mundial de salud. El índice neutrófilo-linfocito, (INL) permite estratificar el riesgo en pacientes con datos de severidad y mal pronóstico, ya que refleja el estado inflamatorio.
Objetivo: determinar si el delta del índice neutrófilo-linfocito predice mortalidad en pacientes con COVID-19.
Material y métodos: se realizó un estudio longitudinal, comparativo en pacientes con COVID-19, mayores de 18 años, ingresados a UCI. Evaluamos HAS, DM, obesidad, EPOC, asma, PaO2/FiO2, severidad tomográfica a su ingreso y a los días 3 y 7 medimos el índice neutrófilo-linfocito, puntaje SOFA y APACHE. En el análisis estadístico, realizamos curvas ROC y Kaplan-Meyer.
Resultados: incluimos 180 pacientes con COVID-19, 63 fallecieron (35%). Se asoció delta INL1 (Día1-día3) > 4.11 con mortalidad (AUC:0.633); sensibilidad 55.56% y especificidad 77.78%, IC95 0.55-0.70, para delta INL2 (día1-día7) > 8.95 (AUC:0.623); sensibilidad 44.44% y especificidad 84.62%, IC95 0.54-0.69. Se observó diferencia en la sobrevida para delta1. La escala SOFA > 6, se asoció a más días de ventilación mecánica y PaO2/FiO2 menor (p < 0.001).
Conclusiones: el delta de INL entre el día de ingreso a UCI y el tercer día de evolución es predictor de mortalidad en pacientes críticamente enfermos.
Abstract
Background: Acute respiratory distress syndrome, due to SARS-CoV-2, is a worldwide health problem. The neutrophil-lymphocyte index allows risk stratification in patients with severe and poor prognostic data, since it reflects the inflammatory state.
Objective: To determine whether the Neutrophil-Lymphocyte Index delta predicts mortality in patients with COVID-19.
Material and methods: We conducted a longitudinal, comparative study in patients with COVID-19, older than 18 years, admitted to the ICU. We evaluated HAS, DM, obesity, COPD, asthma, PaO2/FiO2, tomographic severity. On admission and on days 3 and 7 we measured Neutrophil-Lymphocyte Index, SOFA and APACHE score. For statistical analysis, we performed ROC and Kaplan-Meyer curves.
Results: We included 180 patients with COVID-19, 63 died (35%). Delta INL1 (day1-day3) > 4.11 was associated with mortality (AUC:0.633); sensitivity 55.56% and specificity 77.78%, CI95 0.55-0.70, for delta INL2 (day1-day7) > 8.95 (AUC:0.623); sensitivity 44.44% and specificity 84.62%, CI95 0.54-0.69. Difference in survival was observed for Delta1. SOFA scale > 6, was associated with more days of mechanical ventilation and lower PaO2/FiO2 (p < 0.001).
Conclusions: INL delta between the day of ICU admission and the third day of evolution is a predictor of mortality in critically ill patients.
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