Importancia del índice neutrófilo-linfocito en su asociación con mortalidad en pacientes con COVID-19: Experiencia en un centro de salud en Argentina / Importance of the neutrophil-lymphocyte ratio in its association with mortality in patients with COVID-19: Experience in a health center in Argentina

ANTECEDENTES: El COVID-19 presenta una progresión a cuadros respiratorios graves que pueden culminar con la muerte. Al ser una pandemia, hay necesidad de herramientas de bajo costo que permitan determinar su evolución. El índice neutrófilo-linfocito (INL) es un marcador inflamatorio estudiado en diversas patologías. OBJETIVO: Estimar la asociación entre INL > 3 y mortalidad en pacientes hospitalizados con COVID 19. PACIENTES Y MÉTODOS: Se incluyeron pacientes con diagnóstico de COVID 19 que ingresaron a la sala de internación general de nuestro hospital, desde marzo hasta agosto de 2020. Los pacientes se dividieron en dos grupos: con INL 3. Se realizó un modelo de regresión logística múltiple para estimar la asociación entre el INL > 3 y mortalidad. RESULTADOS: Se incluyeron 711 pacientes con COVID-19. El modelo de regresión logística múltiple mostró asociación entre INL > 3 y mortalidad (OR 3.8; IC95% 1,05 a 13,7; p 0,04) ajustado por edad, días de internación, traslados a terapia intensiva, neumonía grave, valores de proteína-C-reactiva, hipertensión arterial, y comorbilidad neurológica, renal crónica, cardiaca y oncológica previas. COCLUSIÓN: El INL es accesible en la evaluación inicial de los pacientes que se internan con COVID-19, habiéndose asociado en nuestra serie con mortalidad.

BACKGROUND: COVID-19 rapidly progresses to acute respiratory failure and mortality. A pandemic needs an urgent requirement for low-cost and easy-access tools that assess the infection evolution. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker used in several diseases. AIM: To estimate the association between NLR > 3 with mortality in hospitalized patients with COVID 19. METHODS: NLR was analyzed in patients with COVID-19 seen at Hospital Fernandez between March and August 2020. Patients were grouped in those with NLR 3. Clinical characteristics and mortality were analyzed and compared between groups. A multivariable regression model was used to estimate the association between NLR > 3 and mortality. RESULTS: We included 711 patients with COVID-19. In a multivariable regression model, NLR > 3 associated with mortality (OR 3.8; 95% CI 1.05 to 13.7; p 0.04) adjusting by age, days of hospitalization, intensive care requirement, severe pneumonia, C-reactive protein levels, arterial hypertension, and comorbidities. CONCLUSION: NLR was associated with mortality, and it is an accessible and easy tool to use in the first evaluation of hospitalized patients with COVID-19.

Immunoglobulin G Immune Complexes May Contribute to Neutrophil Activation in the Course of Severe Coronavirus Disease 2019.

Severe coronavirus disease 2019 (COVID-19) is associated with an overactive inflammatory response mediated by macrophages. Here, we analyzed the phenotype and function of neutrophils in patients with COVID-19. We found that neutrophils from patients with severe COVID-19 express high levels of CD11b and CD66b, spontaneously produce CXCL8 and CCL2, and show a strong association with platelets. Production of CXCL8 correlated with plasma concentrations of lactate dehydrogenase and D-dimer. Whole blood assays revealed that neutrophils from patients with severe COVID-19 show a clear association with immunoglobulin G (IgG) immune complexes. Moreover, we found that sera from patients with severe disease contain high levels of immune complexes and activate neutrophils through a mechanism partially dependent on FcγRII (CD32). Interestingly, when integrated in immune complexes, anti-severe acute respiratory syndrome coronavirus 2 IgG antibodies from patients with severe COVID-19 displayed a higher proinflammatory profile compared with antibodies from patients with mild disease. Our study suggests that IgG immune complexes might promote the acquisition of an inflammatory signature by neutrophils, worsening the course of COVID-19.

[Importance of the neutrophil-lymphocyte ratio in its association with mortality in patients with COVID-19: Experience in a health center in Argentina]. / Importancia del índice neutrófilo-linfocito en su asociación con mortalidad en pacientes con COVID-19: Experiencia en un centro de salud en Argentina.

BACKGROUND: COVID-19 rapidly progresses to acute respiratory failure and mortality. A pandemic needs an urgent requirement for low-cost and easy-access tools that assess the infection evolution. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker used in several diseases. AIM: To estimate the association between NLR > 3 with mortality in hospitalized patients with COVID 19. METHODS: NLR was analyzed in patients with COVID-19 seen at Hospital Fernandez between March and August 2020. Patients were grouped in those with NLR < 3 and those with NLR > 3. Clinical characteristics and mortality were analyzed and compared between groups. A multivariable regression model was used to estimate the association between NLR > 3 and mortality. RESULTS: We included 711 patients with COVID-19. In a multivariable regression model, NLR > 3 associated with mortality (OR 3.8; 95% CI 1.05 to 13.7; p 0.04) adjusting by age, days of hospitalization, intensive care requirement, severe pneumonia, C-reactive protein levels, arterial hypertension, and comorbidities. CONCLUSION: NLR was associated with mortality, and it is an accessible and easy tool to use in the first evaluation of hospitalized patients with COVID-19.

Valor de la angiografía por tomografía computada en el diagnóstico de aneurismas intracraneanos / Intracraneal aneurysms: three-dimensional CT angiography

A fin de determinar el valor de la Angio TC en el diagnóstico de aneurismas intracraneanos se estudiaron 40 pacientes con cuadro clínico de HSA y/o imagen tomográfica compatible con aneurisma intracraneano. Se reconstruyeron las imágenes en el modo 3D de proyección de intensidad máxima (MIP). Treinta y siete de los pacientes fueron estudiados con angiografía por sustracción digital (ASD). En 34 de los 40 pacientes estudiados se realizó diagnóstico positivo de aneurisma intracraneano. Los 6 restantes presentaron Angio TC normal, siendo uno de ellos falso negativo, puesto en evidencia por la ASD. Concluimos que la Angio TC normal es un método rápido, poco invasivo y muy confiable para la detección de aneurismas intracraneanos que puede ser realizado a continuación del diagnóstico tomográfico de SAH, posibilitando así una cirugía de emergencia