Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients

Abstract

It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) andAbsolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with theseverity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19severity. This research was a retrospective study using medical record data of 376 COVID-19 patients duringApril-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classifiedinto non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routineblood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values wereanalyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. Thesamples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe(4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe(2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showedthat NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2%and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patientsoccurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operatingcharacteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity andspecificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and≤ 1.74x103/μL, respectively.

Analysis of Enoxaparin Effectiveness Based on COVID-19 Severity: A Study in a Secondary Hospital in Bandung, Indonesia

“…Therefore, predicting the severity of a COVID-19 infection is possible with the help of NLR and ALC. NLR has a sensitivity of 91.8% and a specificity of 66.4%, while that of ALC are 81.6% and 64.8% respectively (Selanno et al, 2021). Given that the NLR and ALC levels did not improve, they are not reliable indicators of clinical improvement in COVID-19 patients.…”

“…The antiinflammatory effects of enoxaparin can reduce IL-6 levels in COVID-19 patients, while an increase in TNF-α and IL-6 during a cytokine storm causes lymphopenia (Shi et al, 2020). NLR values typically decrease followed by an increase in lymphocytes as a sign of inflammatory improvement (Selanno et al, 2021). Therefore, predicting the severity of a COVID-19 infection is possible with the help of NLR and ALC.…”

Initial TLC, NLR, LDH, CRP, D-Dimer, and Procalcitonin in Intubated vs Non Intubated COVID-19 Patients

“…Elevated NLR describes an increased inflammatory response and is widely used as a predictor of severity in COVID-19 patients. 15,16 The results of the analysis of laboratory values at the PLA Central Theater General Hospital show the average value of the neutrophillymphocyte ratio (NLR) of patients with severe symptoms was significantly higher than those with mild symptoms. NLR of COVID-19 patients was positively correlated with the C-Reactive Protein, Lactate Dehydrogenase, Procalcitonin, fibrinogen, and D-dimer levels.…”

Hubungan Derajat Penyakit Osteoartritis Lutut dengan Neutrophil Lymphocyte Ratio pada Pasien di RSU Al Fauzan Jakarta Periode 2019-2021

“…20 Distribusi derajat OA lutut pada penelitian ini didapatkan hasil terbanyak pada OA ringan yaitu 45 Orang (60%) dibandingkan dengan OA berat 30 Orang (40%). Hasil ini sesuai dengan penelitian 25 Beberapa publikasi terkini menunjukkan bahwa NLR dapat digunakan sebagai penanda pada inflamasi kronik salah satunya osteoartritis. Hal tersebut terjadi karena pada inflamasi kronik akan terjadi hipersekresi sitokin proinflamasi seperti TNF-α, IL-1β, IL-6, dan IL-8 yang menyebabkan terjadinya peningkatan neutrophil yang menetap.…”

“…Tetapi, pada inflamasi akut ketika terjadi pengeluaran sitokin inflamasi, dengan bersamaan akan terjadi penghancuran sel yang terinfeksi oleh CD8+ sehingga akan terjadi penurunan limfosit secara signifikan (limfopenia). 25 Oleh karena itu, ketika dilakukan pemeriksaan NLR dengan cara membagi jumlah neutrophil dan limfosit akan didapatkan hasil perhitungan NLR yang meningkat. 27 Hal tersebut sesuai dengan penelitian yg dilakukan oleh Gao et al, (2019) yang menyatakan bahwa salah satu penanda yang digunakan untuk mencerminkan keseimbangan respon imun adalah NLR.…”