The neutrophil-to-lymphocyte ratio in bronchoalveolar lavage fluid could help to personalize corticosteroid therapy in severe COVID-19 pneumonia - 29/04/25
, Benjamin Glemain b, c, Anne Fajac d, Vincent Rothstein a, Muriel Fartoukh a, Guillaume Voiriot a, e
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Highlights |
• | Critically ill COVID-19 patients’ bronchoalveolar lavage cytology provides insightful information |
• | A predominant neutrophilic bronchoalveolar phenotype is associated with higher 90-day mortality |
• | Bronchoalveolar cellular phenotype may influence patients’ response to corticosteroids |
• | Patients with a marked neutrophilic phenotype may benefit from higher dose corticosteroids |
• | In patients with a lymphocytic phenotype, higher dose corticosteroids might be harmful |
Abstract |
Objective |
To investigate the response to high-dose corticosteroids according to bronchoalveolar neutrophil-to-lymphocyte ratio (BAL-NLR) in critically-ill COVID-19 patients.
Methods |
We retrospectively analyzed a single-center cohort of adult COVID-19 patients admitted to the intensive care unit with COVID-19 pneumonia between 2020 and 2022, who had a bronchoalveolar lavage and received systemic corticosteroids. We defined high-dose corticosteroid therapy as the administration of at least 1mg/kg/day of methylprednisolone.
Results |
Among 161 patients, 56 had LOWBAL-NLR (<0.8), 55 MILDBAL-NLR (0.8–3.5), and 50 HIGHBAL-NLR (>3.5). A quarter of patients received high-dose corticosteroid therapy. In the HIGHBAL-NLR group, those receiving high-dose corticosteroid therapy had a lower (27 % versus 43 %, p = 0.23) 90-day mortality rate than those receiving a standard dose. In the LOWBAL-NLR group, those receiving high-dose corticosteroid therapy had a higher (31 % versus 12 %, p = 0.12) 90-day mortality rate.
Conclusion |
Our results suggest that bronchoalveolar cellular phenotype influences therapeutic response to high-dose corticosteroid therapy.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, Critical care, Corticosteroid therapy, Bronchoalveolar lavage, Acute respiratory distress syndrome
Plan
Vol 55 - N° 3
Article 105054- mai 2025 Retour au numéro
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