Neutrophil:lymphocyte ratio predicts short-term outcome of COVID-19 in haemodialysis patients

Abstract

Background Information regarding coronavirus disease 2019 (COVID-19) in haemodialysis (HD) patients is limited and early studies suggest a poor outcome. We aimed to identify clinical and biological markers associated with severe forms of COVID-19 in HD patients. Methods We conducted a prospective, observational and multicentric study. Sixty-two consecutive adult HD patients with confirmed COVID-19 from four dialysis facilities in Paris, France, from 19 March to 19 May 2020 were included. Blood tests were performed before diagnosis and at Days 7 and 14 after diagnosis. Severe forms of COVID-19 were defined as requiring oxygen therapy, admission in an intensive care unit or death. Cox regression models were used to compute adjusted hazard ratios (aHRs). Kaplan–Meier curves and log-rank tests were used for survival analysis. Results Twenty-eight patients (45%) displayed severe forms of COVID-19. Compared with non-severe forms, these patients had more fever (93% versus 56%, P < 0.01), cough (71% versus 38%, P = 0.02) and dyspnoea (43% versus 6%, P < 0.01) at diagnosis. At Day 7 post-diagnosis, neutrophil counts, neutrophil:lymphocyte (N:L) ratio, C-reactive protein, ferritin, fibrinogen and lactate dehydrogenase levels were significantly higher in severe COVID-19 patients. Multivariate analysis revealed an N:L ratio >3.7 was the major marker associated with severe forms, with an aHR of 4.28 (95% confidence interval 1.52–12.0; P = 0.006). After a median follow-up time of 48 days (range 27–61), six patients with severe forms died (10%). Conclusions HD patients are at increased risk of severe forms of COVID-19. An elevated N:L ratio at Day 7 was highly associated with the severe forms. Assessing the N:L ratio could inform clinicians for early treatment decisions.

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“…Out of all these ratios, in our study, NLR and LCR were associated with the severe form and mortality. Very similar observer data by Qin et al [ 26 ] showed that an NLR >5.2 was associated with the most severe form of COVID-19 within a cohort of 452 patients, while Mutinelli-Szymanski et al [ 15 ], in a prospective, observational, and multicentric study of 62 adult HD patients, observed that an NLR >3.7 at day 7 was associated with the severe form and with poor survival. Therefore, we believe that NLR and LCR could be helpful for clinicians to identify patients who may develop a severe form of the disease at an early stage.…”

“…However, the NLR, PLR, MLR, and LCR are biomarkers of systemic inflammation, available in almost all laboratories, and are rarely used in this infection. The first of them has been the most thoroughly studied and has shown prognostic ability in multiple clinical settings, such as acute kidney injury [ 27 ], kidney disease [ 28 ], cardiovascular disease [ 29 ], ANCA-associated vasculitis [ 30 ], cancer patients [ 31 ], renal transplantation [ 32 ], and recently COVID-19 as a short-term predictor marker associated with severe forms of COVID-19 in HD patients [ 15 , 18 , 33 ]. In our study, the CRP levels at diagnosis were almost double in patients who died, as compared to survivors.…”

“…Recent studies have described the incidence, clinical and radiologic features, laboratory characteristics, and hyperinflammatory parameters, therapeutic strategies, recovery, evolution, outcome, and screening of COVID-19 in MHD patients [10,11,[14][15][16][17][18]23]. However, there are few studies on the technique and the dialyzer used in patients with COVID-19 undergoing hemodialysis [10,19,20], as well as on the response of this infection on the removal of the inflammatory parameters.…”

SARS-CoV-2 assessment in an outpatient dialysis facility of a single center in Brazil

“…Symptoms such as fever, asthenia, cough and dyspnea were more frequent in the severe group, consistent with the results of a previous study performed on dialysis patients. 8 , 9 …”

“…In previous studies, laboratory indices associated with worse COVID-19 prognosis included d-dimer, LDH, CRP, thrombocytopenia, lymphopenia and liver dysfunction. 8 , 9 , 10 , 11 Another study found that the N:L ratio was the major marker associated with severe forms and predicted short-term COVID-19 outcomes in hemodialysis patients. 9 …”