Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients

Ma, Aijia; Cheng, Jiangli; Yang, Jing; Dong, Meiling; Liao, Xuelian; Kang, Yan

doi:10.1186/s13054-020-03007-0

Cited by 118 publications

(114 citation statements)

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“…In this study, patients with CSI had high NLR and CRP levels and low s-Alb levels, similar to those in previous studies [ [18] , [19] , [20] ]. High NLR is associated with systemic inflammation [ 21 , 22 ].…”

Section: Discussionsupporting

confidence: 90%

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Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

Hirashima

Arai

Kitajima

et al. 2021

Journal of Infection and Chemotherapy

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Introduction The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. Methods All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients’ records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. Results Data from 61 patients (16 Pt–CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt–CSI were significantly older and had hypertension or diabetes than Pt-MMI ( P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt–CSI than in Pt-MMI ( P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt–CSI than in Pt-MMI ( P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt–CSI than in Pt-MMI ( P = 0.013). Among the 16 Pt–CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. Conclusions The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.

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Section: Discussionsupporting

confidence: 90%

“…Previous studies [ 18 , 19 ] reported that NLR can be used to identify high-risk patients with moderate–severe ARDS, with an optimal threshold value of 9.8 [ 18 ] or 3.13 [ 19 ]. Wang et al.…”

Section: Discussionmentioning

confidence: 99%

Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

Hirashima

Arai

Kitajima

et al. 2021

Journal of Infection and Chemotherapy

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“…Recently, more and more studies have found that NLR is signi cantly different between the mild/moderate and severe/critical groups, survival and death group in COVID-19 patients. In addition, a series of studies have suggested NLR is a reliable predictor of COVID-19 progression and elevated NLR is associated with high mortality [15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Liu

Mao

et al. 2020

Preprint

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Background：Coronavirus disease 2019 (COVID-19), a highly infectious disease, has been rapidly spreading all over the world and posted a great threat to global public health. Patients diagnosed with severe or critical cases have a poor prognosis. Hence, it is crucial for us to identify potential severe or critical cases early, and give timely treatments for the targeted patients. In the clinical practice of treating COVID-19 patients, we have observed that the neutrophil-to-lymphocyte ratio (NLR) of severe patients is higher than that in mild patients. We performed this systematic review and meta-analysis to evaluate the predictive values of NLR on disease severity and mortality in COVID-19 patients. Methods: We searched PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify eligible studies (up to August 11, 2020). Two authors independently screened studies and extracted data. The methodological quality of the included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).Results: Thirteen studies involving 1579 patients reported the predictive value of NLR on disease severity. The pooled sensitivity (SEN), specificity (SPE) and area under curve (AUC) were 0.78 (95% CI 0.70-0.84), 0.78 (95% CI 0.73-0.83) and 0.85 (95% CI 0.81-0.88), respectively. Ten studies involving 2967 patients reported the predictive value of NLR on mortality. The pooled SEN, SPE and AUC were 0.83 (95% CI 0.75-0.89), 0.83 (95% CI 0.74-0.89) and 0.90 (95% CI 0.87-0.92), respectively. Conclusions: NLR has good predictive values on disease severity and mortality in COVID-19 patients. Evaluating NLR can help clinicians identify potentially severe cases early, conduct early triage and initiate effective management in time, which may reduce the overall mortality of COVID-19. Moreover, we can better allocate scarce medical resources in this unprecedented time. Trial registration: This meta-analysis was prospectively registered on PROSPERO database (Registration number: CRD42020203612).

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“…In a recent study, Dr. Ma [ 1 ] investigated the neutrophil to lymphocyte ratio (NLR) in predicting moderate-severe acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection. They reported that NLR was significantly higher ARDS group and was a good predictor for moderate-severe ARDS, with area under curve (AUC) 0.749.…”

mentioning

confidence: 99%

Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19

2020

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Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients

Abstract: Trial registrationChiCTR, ChiCTR2000029758. Registered 12 February 2020 - Retrospectively registered

Cited by 118 publications

References 5 publications

Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19

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