Complete blood count derived inflammation indexes predict outcome in COVID-19 patients: a study in Indonesia

Abstract

Introduction: Inflammation plays a vital role in the pathophysiology of COVID-19. Complete blood count (CBC) is a routine test performed on patients. It provides information regarding the inflammatory process and can be used as a predictor of outcome. This study aimed to explore the correlation between different complete blood count (CBC)-derived inflammation indexes at hospital admission, such as neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte × platelet ratio (NLPR), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII), to in-hospital mortality in confirmed COVID-19 patients. Methodology: A retrospective observational study was performed at Ulin Referral Hospital of South Kalimantan with 445 COVID-19 patients from April to November 2020. The patients were divided into two groups, non-survivor and survivor. A receiver operating characteristic (ROC) curve was used to determine the cut-off values. Bivariate analysis was performed using the Chi Square test, the risk ratio was calculated, and logistics regression was determined. Results: Increase of NLR, dNLR, PLR, MLR, NLPR, MLR, AISI, SIRI, and SII from cut-off values were significantly correlated with patient survival outcome. The cut off values were 6.90, 4.10, 295, 0.42, 0.037, 1,422, 1.80, and 2,504 respectively. NLPR was dominant in predicting in-hospital mortality (OR: 6.668, p = 0.000) with a 28.1% sensitivity and 95.9% specificity. Conclusions: CBC-derived inflammation indexes were associated with the survival outcome of confirmed COVID-19 patients and NLPR was a dominant variable.

Prognostic Performance of Inflammatory Biomarkers Based on Complete Blood Counts in COVID-19 Patients

“…Together, these known pathomechanisms provide the rationale to include lymphocyte, neutrophil, monocyte, and platelet counts to assess complete-blood-count-based biomarkers to predict COVID-19 outcome [ 17 ]. The NLR, determined at the time of admission to the hospital, has been frequently used as a prognostic biomarker and was included in the present study as a comparator to more complex markers such as the PIV, which has not yet been studied in COVID-19 patients [ 17 , 18 , 19 ]. Indeed, our data confirm results of previous studies showing that the baseline NLR is an independent predictor of COVID-19-associated death and severity, as classified by the WHO.…”

Aggregate Index of Systemic Inflammation (AISI), Disease Severity, and Mortality in COVID-19: A Systematic Review and Meta-Analysis

“…After initially identifying 52 articles, 36 were removed (either duplicates or irrelevant). After full-text review, a further three were excluded (missing data: two studies; participants aged <18 years: one study), leaving 13 articles, all retrospective studies, for final analysis (Figure 1) [25,[40][41][42][43][44][45][46][47][48][49][50][51]. Clinical endpoints included mortality (11 study groups) [25,40,43,44,[47][48][49][50][51], and the following measures of disease severity: transfer to the intensive care unit (two study groups) [42,46], invasive mechanical ventilation (two study groups) [44,45], prolonged hospital stay (one study group) [41], acute limb ischemia (one study group) [42], deep vein thrombosis (one study group) [47], and acute pulmonary embolism (one study group) [47].…”

“…The AISI was measured on admission in all studies. The risk of bias and the initial certainty of evidence (case-control design; rating 2, ⊕⊕ ) were low in all studies (Supplementary Table S3) [25,[40][41][42][43][44][45][46][47][48][49][50][51].…”

“…After full-text review, a further three were excluded (mi participants aged <18 years: one study), leaving 13 articles, all r final analysis (Figure 1) [25,[40][41][42][43][44][45][46][47][48][49][50][51]. Clinical endpoints includ groups) [25,40,43,44,[47][48][49][50][51], and the following measures of diseas intensive care unit (two study groups) [42,46], invasive mechanic groups) [44,45], prolonged hospital stay (one study group) [41], a study group) [42], deep vein thrombosis (one study group) [47 embolism (one study group) [47]. The AISI was measured on adm risk of bias and the initial certainty of evidence (case-control de were low in all studies (Supplementary Table S3) [25,[40][41][42][43][44][45][46][47][48][49][50][51].…”

“…Eleven studies (including 15 patient groups) reported the diagnostic accuracy of the AISI towards severe disease or death in 7427 COVID-19 patients (56% males, mean age 58 years) (Table 3) [25,[40][41][42][43][45][46][47][48][49][50]. Six studies were conducted in Europe [25,[40][41][42]45,47], four in Asia [43,[48][49][50], and one in Africa [46].…”