Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease–a report from a highly complex hospital in Brazil

Oliveira, Douglas Câmara de; Spiri, Beatriz Sanada; Schluga, Yara; Justus, Julie Lilian P.; Neto, Francisco Diego Negrão Lopes; Azambuja, Ana Paula de

doi:10.1016/j.htct.2022.05.007

Cited by 5 publications

(7 citation statements)

References 28 publications

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“…However, to date, no optimal cut-off value has been validated across different populations [17]. As vaccination results in the activation of T and B lymphocytes, which could last for months, the NLR may not be a useful laboratory marker in vaccinated patients with COVID-19 [18].…”

Section: Introductionmentioning

confidence: 99%

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

Chelariu

Coman

Lionte

et al. 2022

JPM

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Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a patient’s inflammatory response to infectious diseases. Aim: This was a prospective cohort study that aimed to assess the prognostic value of scores based on CBCs in hospitalized patients with mild or moderate COVID-19 and medical comorbidities regarding the need for intensive care unit (ICU) therapy and short-term mortality. Methods: We included 607 patients with confirmed COVID-19, followed up for the need for ICU admission (15.5%) and 30 day mortality post-discharge (21.7%). CBC-derived scores were tested upon emergency department (ED) admission and after a median of 8 days. Results: In a multivariate model, elevated followed-up neutrophil-to-lymphocyte ratio (NLR) predicted increased odds for ICU admission (OR: 1.14 [95%CI: 1.06–1.22], p < 0.001) and short-term mortality (OR: 1.30 [95%CI: 1.09–1.57], p = 0.005). Monocyte-to-lymphocyte ratio (MLR) predicted 2.5-fold increased odds for ICU admission and 2.2-fold increased odds for mortality. Conclusion: NLR and MLR followed up 8 days post-admission are predictive for adverse outcomes in mild or moderate COVID-19 patients.

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Section: Introductionmentioning

confidence: 99%

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

Chelariu

Coman

Lionte

et al. 2022

JPM

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“…Regarding lymphocyte counts, these results did not show a significant difference between severe and mild groups or between deceased and survivor groups. Other research demonstrated a decrease in lymphocyte counts in severe patients (35,36,39). Oliveira et al also revealed that lymphocyte counts in the COVID-19 groups were not statistically different from those in the control group (39).…”

Section: Discussionmentioning

confidence: 89%

“…Other research demonstrated a decrease in lymphocyte counts in severe patients (35,36,39). Oliveira et al also revealed that lymphocyte counts in the COVID-19 groups were not statistically different from those in the control group (39). It is worth noting that the excessive inflammation described in SARS-COV-2 infection can persuade immune-mediated dyslipidemia, especially HDL-C reduction, through decreased production (6,40,41).…”

Section: Discussionmentioning

confidence: 93%

Assessment of Leukocyte Subtypes to High-Density Lipoprotein-Cholesterol (HDL-C) Ratios as predictors of Severity and Mortality in COVID-19 Patients

Hosseini,

Rohani-Rasaf,

Vatannejad

et al. 2023

ABI

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Objectives: Recently, the counts of leukocyte subtypes to HDL-C concentration ratios, including monocyte to HDL-C ratio (MHR), neutrophil to HDL-C ratio (NHR), lymphocyte to HDL-C (LHR) have been proposed as potential new indices of inflammation. This study aims to investigate the correlation between these indices with the severity and mortality of COVID-19. Methods: This study is performed on 1224 non-vaccinated and hospitalized COVID-19 patients. The association between blood parameters and indices on admission with severity and mortality are analyzed using multivariate regression models. Receiver operating characteristic curves are used to compare the utility of different blood parameters. Results: The severe patients and deceased groups show low level of HDL-C, high values of WBC, neutrophil, monocyte, eosinophil, WBC/HDL-C, NHR, MHR, LHR, and EHR compared with the mild and survivor groups, respectively (P < 0.05). Multivariate regression analysis reveals that high levels of WBC, neutrophil, WBC/HDL-C, NHR, MHR, EHR, and low levels of HDL-C are still independently associated with severity and mortality after adjusting for age, gender, and comorbidities. The correlation of LHR with severity and mortality is attenuated to insignificance. Also, patients with high eosinophil and monocyte levels have a higher risk of severe disease. According to the AUC values, the best predictors for severity are the level of WBC, neutrophil, and NHR (AUC: 0.724, 0.725, 0.724 respectively), and the best predictors for mortality are WBC/HDL-C and NHR (AUC: 0.788, 0.790 respectively). Conclusion: In summary, low level of HDL-C and high level of WBC, neutrophil, WBC/ HDL-C, NHR, MHR, and EHR which can be easily calculated from the CBC and HDL-C concentrations, may provide valuable and readily available prognostic information for severity and mortality of COVID-19.

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“…Several studies detected a significant reduction in total lymphocytes count and in CD3 + and CD4 + CD8 + T-cell subsets, both at the early stages and in severe forms of COVID-19-associated disease in deceased hospitalized patients compared to survivors [ 34 , 35 , 36 , 37 ]. Interestingly, a Brazilian study found that reduction of T-cell subtypes is a prognostic factor not only of death but also of need for intubation [ 38 ]. In addition to lymphocyte subsets, a high neutrophil-to-lymphocyte ratio has been considered a sensible parameter of negative outcome in COVID-19 [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, a Brazilian study found that reduction of T-cell subtypes is a prognostic factor not only of death but also of need for intubation [ 38 ]. In addition to lymphocyte subsets, a high neutrophil-to-lymphocyte ratio has been considered a sensible parameter of negative outcome in COVID-19 [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Inflammation as Prognostic Hallmark of Clinical Outcome in Patients with SARS-CoV-2 Infection

Fuzio¹,

Inchingolo

Ruggieri³

et al. 2023

Life

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often characterized by a life-threatening interstitial pneumonia requiring hospitalization. The aim of this retrospective cohort study is to identify hallmarks of in-hospital mortality in patients affected by Coronavirus Disease 19 (COVID-19). A total of 150 patients admitted for COVID-19 from March to June 2021 to “F. Perinei” Murgia Hospital in Altamura, Italy, were divided into survivors (n = 100) and non-survivors groups (n = 50). Blood counts, inflammation-related biomarkers and lymphocyte subsets were analyzed into two groups in the first 24 h after admission and compared by Student’s t-test. A multivariable logistic analysis was performed to identify independent risk factors associated with in-hospital mortality. Total lymphocyte count and CD3+ and CD4+ CD8+ T lymphocyte subsets were significantly lower in non-survivors. Serum levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), C-reactive protein (CRP) and procalcitonin (PCT) were significantly higher in non-survivors. Age > 65 years and presence of comorbidities were identified as independent risk factors associated with in-hospital mortality, while IL-6 and LDH showed a borderline significance. According to our results, markers of inflammation and lymphocytopenia predict in-hospital mortality in COVID-19.

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Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease–a report from a highly complex hospital in Brazil

Cited by 5 publications

References 28 publications

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

Assessment of Leukocyte Subtypes to High-Density Lipoprotein-Cholesterol (HDL-C) Ratios as predictors of Severity and Mortality in COVID-19 Patients

Inflammation as Prognostic Hallmark of Clinical Outcome in Patients with SARS-CoV-2 Infection

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