Auteur(s) : Simon, Paul
Directeur : Laure Abensur Vuillaume
Composante : MEDECINE
Date de création : 30-06-2022

Description : Médecine (médecine d'urgence), Background: For more then two years, the world has been facing a pandemic of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the most severe form of which manifested itself as an acute respiratory distress syndrome (ARDS) representing its main cause of mortality. In the context of the ongoing pandemic and the overload and exhaustion of the hospital system, it seems appropriate to remain vigilant and to find markers to better discriminate between patients likely to develop the most severe forms, requiring increased surveillance and intensive care. Recent studies suggest that the platelet-to-lymphocyte ratio (PLR) is a good marker of inflammatory and thrombotic states and has been evaluated in cancer, inflammatory and cardiovascular diseases. The aim of this study was therefore to determine whether the PLR could be a marker capable of predicting severity and mortality in patients infected with SARS-CoV-2 upon admission to the emergency department. Method: We conducted a retrospective multicentre study on a cohort of patients included between March 1 and April 30, 2020, with a positive diagnosis of SARS-CoV-2 infection by RT-PCR in the emergency department and who were hospitalised at the time of admission to manage moderate to severe forms of COVID-19 (coronavirus disease 2019). Results: A total of 1035 patients were included in our study. None of the observed biological parameters (lymphocyte count, platelet count, platelet-to-lymphocyte ratio) were associated with disease severity. Lymphocyte counts were significantly lower and PLR values significantly higher in the group of patients who died and both biological parameters were associated with mortality in the univariate analysis (respectively (OR: 0.524, 95% CI: (0.336-0.815), p = 0.004) and (OR: 1.001, 95% CI: (1.000-1.001), p = 0.042). However, the only biological parameter with a significant association with mortality on multivariate analysis was platelet count (OR: 0.996, 95% CI: (0.996-1.000), p = 0.027). The best predictor of COVID-19 mortality was PLR 356.6 (OR: 3.793, 95% CI: (1.946-7.394), p < 0.001) with a sensitivity of 34% and specificity of 82%. Conclusion: Despite the pathophysiological mechanisms underlying SARS-CoV-2 infection that make the PLR a dedicated marker, it does not appear to be a marker for predicting disease severity in the study population. However, a high LRP appears to be associated with excess mortality and, in the context of disease progression and management, further studies are needed to confirm this., Thèses et écrits académiques
Mots-clés libres : Mortalité, Covid-19, SARS-CoV-2 (virus), PLR, Ratio plaquette-sur-lymphocyte, Sévérité, 616.025
Couverture : FR