Neutrophil to Lymphocyte Ratio and Hs-CRP Predict Mortality in COVID-19 Patients

Abstract

Background: Inflammation plays an important role in the pathogenesis of COVID-19 and can be an important factor in the prognosis. The innate immune response to a respiratory infection is characterised by an influx of neutrophils to the lungs, particularly the alveoli. A sustained release of anti-inflammatory cytokines may lead to widespread apoptosis of lymphocytes, resulting in lymphopenia. Hs-CRP is an indicator of COVID-19 inflammation. The aim of this study was to analyse Neutrophilto-Lymphocyte Ratio (NLR) and Hs-CRP in order to predict mortality in COVID-19 patients. Research methods: This research was conducted at Moewardi Hospital in July 2020. The subjects were COVID-19 patients. NLR is neutrophils divided by lymphocytes using a haematology analyser. The examination of Hs-CRP was conducted utilizing the ELISA method. Statistical test with an independent T-test and cox proportional hazard analysis with p <0.05 was also used. Results: The results showed that Hs-CRP and NLR increased in COVID-19 patients who later died and obtained lower levels of surviving (p = 0.001 and p = 0.11). Hs-CRP increased the risk of death for COVID-19 patients (p = 0.18; HR = 1.036) and NLR also increased the risk of death for COVID-19 patients (p = 0.08; HR = 1.34) Conclusion: Neutrophil-to-Lymphocyte Ratio and Hs-CRP predicted mortality in COVID-19 patients

The Effect of C-Reactive Protein Levels, Neutrophil, and Lymphocyte Count to Mortality of COVID-19 Patients with Sepsis in Referral Hospital

“…Based on exp(b) ratio, patients with increasing CRP rates have a mortality risk of 1,047 times greater than those with low CRP levels. Meanwhile, patients with an increasing Open access under CC-BY-NC-SA 4.0 International License 31 showed that NLR increase in COVID-19 patients increased the risk of death. 31 Both neutrophils and CRP levels play a role and are directly involved in the human body's defense systems when there is both infection and inflammation.…”

“…Meanwhile, patients with an increasing Open access under CC-BY-NC-SA 4.0 International License 31 showed that NLR increase in COVID-19 patients increased the risk of death. 31 Both neutrophils and CRP levels play a role and are directly involved in the human body's defense systems when there is both infection and inflammation. Previous studies have proved that each of these variables has significant correlation to the severity of both COVID-19 and sepsis and affects its mortality.…”

Hubungan Kadar High-Sensitivity C-Reactive Protein dengan Mortalitas Penderita COVID-19 di Rumah Sakit Universitas Sebelas Maret

“…Kadar hs-CRP berkaitan dengan risiko penyakit kardiovaskular seperti penyakit jantung koroner, infark miokard, stroke iskemik, hingga kematian serta memiliki kekuatan lebih dibandingkan LDL-C sebagai prediktor terhadap kejadian kardiovaskular. Kadar hs-CRP memiliki korelasi terbalik dengan kapasitas fungsional dan Left Ventricular Ejection Fraction (LVEF) sehingga peningkatan kadar dapat menunjukkan risiko lebih tinggi mengalami mortalitas pada pasien CHF serta proses inflamasi memiliki peran penting dalam kondisi tersebut [19][20].…”

“…Keberadaan CRP menjadi biomarker inflamasi serta berperan langsung dalam proses patologis dengan dampak multiple organ damage tersebut dapat menunjukkan keterkaitan dan prognosis buruk termasuk tingkat keparahan hingga kematian pada COVID-19 bila terdapat peningkatan kadar [15,19,23]. Pada populasi Indonesia, hasil penelitian ini memiliki kesesuaian dengan studi oleh Nurhayatun et al [20] yang menunjukkan bahwa peningkatan kadar hs-CRP berkorelasi dengan tingkat mortalitas (pvalue = 0.001). Pemeriksaan hs-CRP pada awal diagnosis sebagai prediktor kematian COVID-19 dapat menjadi perhatian dan pertimbangan bagi klinisi untuk memberikan perawatan lebih intensif bila pasien menunjukkan peningkatan kadar hs-CRP [20].…”

Correlation of Interleukin-6 Level with Neutrophil to Lymphocyte Ratio and Disease Severity in COVID-19 Patients

“…2 There is no specific examination as a severity predictor for patients, so it is necessary to find factors that can be used to estimate clinical severity in COVID-19 patients, which will signal when the patients meet the predictors of death so they will get the maximum treatment immediately. 4,7 Our research aims to investigate the immune-inflammatory markers in the peripheral blood of patients with various forms of COVID-19, then evaluate the correlation between serum interleukin-6 and NLR in predicting disease severity in COVID-19 patients.…”