Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?

Abstract

SUMMARY OBJECTIVE The present study aimed to investigate the role of neutrophil/lymphocyte ratio (NLR), an inflammation marker, complete blood count, and biochemical parameters in the diagnosis of COVID-19. METHODS A total of 80 patients who had been hospitalized in the internal medicine clinic were enrolled in the study. The cases were allocated into two groups, i.e., COVID (+) and (-), based on real-time reverse transcription-polymerase chain reaction. The demographic, clinical, and laboratory [NLR, platelet/lymphocyte ratio (PLR), complete blood count, biochemistry, and serology] data of the patients were retrospectively obtained from the hospital data management system. RESULTS NLR and fever levels were found to be higher in COVID-19 (+) cases (P=0.021, P=0.001, respectively). There was no difference between males and females with regard to COVID-19 positivity (P=0.527). Total bilirubin levels were found to be lower in COVID-19 (+) cases (P=0.040). When the ROC analysis was carried out for NLR in COVID-19 (+) cases, the AUC value was found to be 0.660 (P=0.021), sensitivity as 69.01 %, specificity as 65.40 %, LR+: 1.98 and LR- : 0.48, PPV: 80.43, and NPV: 50.00, when the NLR was ≥2.4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSION NLR is an independent predictor for the diagnosis of COVID-19. We also found that fever and total bilirubin measurements could be useful for the diagnosis of COVID-19 in this population.

Laboratory Biomarkers of COVID-19 Disease Severity and Outcome: Findings from a Developing Country

“…Therefore, this biomarker is an indirect indication of the body's stress level due to the severity of the disease. This is also similar with findings from other studies where NLR was found to an important predictor of disease severity and outcome (3,(5)(6)(7)(8).…”

“…Different laboratory markers are implicated as an indicator of disease severity, progression and outcome. Deranged cell counts, like anemia, polycythemia, leukopenia and leukocytosis with neutrophil predominance and decreased platelet count are found to be associated with severe disease and worse outcome in hospitalized patients (2)(3)(4)(5)(6)(7)(8)(9). Similarly raised liver enzymes and total bilirubin levels were identified in severe and critical patients (6,(10)(11)(12)(13)(14)(15).…”

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Recently, several studies have reported that NLR may differentiate between mild/moderate and severe/critical groups and probability of death in patients with COVID-19 infection. In addition, a series of studies have suggested NLR is a reliable predictor of COVID-19 progression and elevated NLR is associated with high mortality [15][16][17][18][19][20].…”

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Recently, more and more studies have found that NLR is signi cantly different between the mild/moderate and severe/critical groups, survival and death group in COVID-19 patients. In addition, a series of studies have suggested NLR is a reliable predictor of COVID-19 progression and elevated NLR is associated with high mortality [15][16][17][18][19][20].…”