The neutrophil-to-lymphocyte ratio in bronchoalveolar lavage fluid could help to personalize corticosteroid therapy in severe COVID-19 pneumonia.

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.