1. The Neutrophil-to-Lymphocyte Ratio Determines Clinical Efficacy of Corticosteroid Therapy in Patients with COVID-19
- Author
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Cai, Jingjing, Li, Haomiao, Zhang, Changjiang, Chen, Ze, Liu, Hui, Lei, Fang, Qin, Juan-Juan, Liu, Ye-Mao, Zhou, Feng, Song, Xiaohui, Zhou, Jianghua, Zhao, Yan-Ci, Wu, Bin, He, Meiling, Yang, Huilin, Zhu, Lihua, Zhang, Peng, Ji, Yan-Xiao, Zhao, Guang-Nian, Lu, Zhigang, Liu, Liming, Mao, Weiming, Liao, Xiaofeng, Lu, Haofeng, Wang, Daihong, Xia, Xigang, Huang, Xiaodong, Wei, Xiang, Xia, Jiahong, Zhang, Bing-Hong, Yuan, Yufeng, She, Zhi-Gang, Xu, Qingbo, Ma, Xinliang, Wang, Yibin, Yang, Juan, Zhang, Xin, Zhang, Xiao-Jing, and Li, Hongliang
- Subjects
Patient Safety ,Diabetes ,Clinical Research ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Metabolic and endocrine ,Good Health and Well Being ,Adrenal Cortex Hormones ,Area Under Curve ,COVID-19 ,Diabetes Mellitus ,Type 2 ,Humans ,Hyperglycemia ,Length of Stay ,Lymphocytes ,Neutrophils ,Proportional Hazards Models ,ROC Curve ,Risk Factors ,SARS-CoV-2 ,Severity of Illness Index ,Survival Rate ,Treatment Outcome ,COVID-19 Drug Treatment ,corticosteroids ,inflammatory status ,mortality ,neutrophil-to-lymphocyte ratio ,Biochemistry and Cell Biology ,Medical Biochemistry and Metabolomics ,Endocrinology & Metabolism - Abstract
Corticosteroid therapy is now recommended as a treatment in patients with severe COVID-19. But one key question is how to objectively identify severely ill patients who may benefit from such therapy. Here, we assigned 12,862 COVID-19 cases from 21 hospitals in Hubei Province equally to a training and a validation cohort. We found that a neutrophil-to-lymphocyte ratio (NLR) > 6.11 at admission discriminated a higher risk for mortality. Importantly, however, corticosteroid treatment in such individuals was associated with a lower risk of 60-day all-cause mortality. Conversely, in individuals with an NLR ≤ 6.11 or with type 2 diabetes, corticosteroid treatment was not associated with reduced mortality, but rather increased risks of hyperglycemia and infections. These results show that in the studied cohort corticosteroid treatment is associated with beneficial outcomes in a subset of COVID-19 patients who are non-diabetic and with severe symptoms as defined by NLR.
- Published
- 2021