Neutrophil/Lymphocyte Ratio (NLR) and Lymphocyte/Monocyte Ratio (LMR) – Risk of Death Inflammatory Biomarkers in Patients with COVID-19

Abstract

Aim The aim of our retrospective study was search for new prognostic parameters, which can help quickly and cheaply identify patients with risk for severe course of SARS-CoV-2 infection. Materials and Methods The following peripheral blood combination biomarkers were calculated: NLR (neutrophil/lymphocytes ratio), LMR (lymphocyte/monocyte ratio), PLR (platelet/lymphocyte ratio), dNLR (neutrophils/(white blood cells − neutrophils)), NLPR (neutrophil/(lymphocyte × platelet ratio)) in 374 patients who were admitted to the Temporary Hospital no 2 of Clinical Hospital in Bialystok (Poland) with COVID-19. The patients were divided into four groups depending on the severity of the course of COVID-19 using MEWS classification. Results The NLR and dNLR were significantly increased with the severity of COVID-19, according to MEWS score. The AUC for the assessed parameters was higher in predicting death in patients with COVID-19: NLR (0.656, p=0.0018, cut-off=6.22), dNLR (0.615, p=0.02, cut-off=3.52) and LMR (0.609, p=0.03, cut-off=2.06). Multivariate COX regression analysis showed that NLR median above 5.56 (OR: 1.050, P=0.002), LMR median below 2.23 (OR: 1.021, P=0.011), and age >75 years old (OR: 1.072, P=0.000) had a significant association with high risk of death during COVID-19. Conclusion Our results indicate that NLR, dNLR, and LMR calculated on admission to the hospital can quickly and easy identify patients with risk of a more severe course of COVID-19. Increase NLR and decrease LMR have a significant predictive value in COVID-19 patient’s mortality and might be a potential biomarker for predicting death in COVID-19 patients.

Assessing the Diagnostic Values of the Neutrophil-to-Lymphocyte Ratio (NLR) and Systematic Immunoinflammatory Index (SII) as Biomarkers in Predicting COVID-19 Severity: A Multicentre Comparative Study

“…Our previous multicentre study in Saudi Arabia demonstrated the prognostic value of the NLR in detecting severe COVID-19 cases, i.e., admitted to the ICU, compared to both non-severe cases and non-COVID-19 patients [9]. Such a finding was later confirmed and was found to be applicable to other cohorts locally [15,16] and internationally [17][18][19]. More recently, the works of Regolo et al demonstrated the value of the NLR as an independent predictor of mortality in separate studies including over 1000 patients with COVID-19 [20,21].…”

Factors Associated with Mortality Among Severe Omicron Patients for COVID-19

“… 15 , 24 Additionally, dNLR is a variable in risk-scoring models which associate with critical illness in COVID-19 patients. 25 Several studies have recognized its independent significance in affecting mortality. 16 , 26 Similarly, our study confirmed that dNLR >5.0 was associated with death in patients with severe omicron infection.…”

Redox Biomarkers – An Effective Tool for Diagnosing COVID-19 Patients and Convalescents

“…The immune response to the infection is complex and highly individualized, which undoubtedly affects the severity of disease symptoms and complications after the infection. 1 Research has shown that severe COVID-19 is not directly caused by the SARS-CoV-2, but by the cytokine storm which increases the production of reactive oxygen species (ROS) that induce oxidative stress. 2 An infection caused by the SARS-CoV-2 leads to the activation of neutrophils and mononuclear phagocytic cells which are largely responsible for the massive release of ROS in lung tissues.…”