Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis

Simadibrata, Daniel Martin; Calvin, Julius; Wijaya, Andi; Ibrahim, Nurhadi

doi:10.1016/j.ajem.2021.01.006

Cited by 142 publications

(105 citation statements)

References 60 publications

(63 reference statements)

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“…Lastly, Spearman's rho correlations were calculated for the laboratory markers. We also included in this analysis the neutrophil to lymphocyte and the platelet to lymphocyte ratios, which have been shown to be predictive biomarkers of severity in COVID-19 [18,19]. All analyses were performed by using the R 4.0.5 software.…”

Section: Discussionmentioning

confidence: 99%

Patients Admitted for Variant Alpha COVID-19 Have Poorer Outcomes than Those Infected with the Old Strain

Vassallo

Manni

Klotz

et al. 2021

JCM

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Objectives: The variant alpha COVID-19 rapidly spread across Europe in early 2021. While this variant’s increased infectivity has been proven, little is known of its clinical presentation and outcomes compared to the old strain. Methods: We identified patients admitted to the Cannes General Hospital for variant alpha-related COVID-19 infection from January to April 2021. Their main demographic parameters, inflammatory markers and clinical characteristics were recorded. Patients admitted from October to December 2020 for 20E (EU1) COVID-19 were selected as controls. Differences between groups were analyzed. Results: We included 157 patients (mean age 73 years; 58% men; mean delay of symptoms 6.9 days). Comorbidities were present in 92% (mainly hypertension, diabetes and obesity or overweight). The prevalence of comorbidities did not differ between groups. In 28% of cases, patients either died or required transfer to the Intensive Care Unit (ICU). The cause of death or of transfer to the ICU was presumably associated with severe pneumonia. Variant alpha COVID-19 had 3.8-fold higher risk of death or transfer to the ICU compared to the old strain. Discussion: Patients infected with variant alpha COVID-19, despite similar background characteristics, had a higher risk of unfavorable outcomes than those infected with the old strain, suggesting increased virulence related to this variant.

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Section: Discussionmentioning

confidence: 99%

Patients Admitted for Variant Alpha COVID-19 Have Poorer Outcomes than Those Infected with the Old Strain

Vassallo

Manni

Klotz

et al. 2021

JCM

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“…A panel of 53 putative biomarkers was analyzed (Additional file 1 : Table S1). Validated biomarkers routinely used in patients care that are associated to COVID-19 severity and might predict outcome were assessed, including concentration of C-reactive protein, creatinine and LDH (Danwang et al 2020 ; Tian et al 2020 ; Ji 2020 ) and assessment of the NLR (Simadibrata et al 2021 ). The PaO 2 /FiO 2 ratio was used as a surrogate marker of hypoxia (< 300 mm Hg).…”

Section: Methodsmentioning

confidence: 99%

CXCL10 levels at hospital admission predict COVID-19 outcome: hierarchical assessment of 53 putative inflammatory biomarkers in an observational study

Lorè

Lorenzo

Rancoita

et al. 2021

Mol Med

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Background Host inflammation contributes to determine whether SARS-CoV-2 infection causes mild or life-threatening disease. Tools are needed for early risk assessment. Methods We studied in 111 COVID-19 patients prospectively followed at a single reference Hospital fifty-three potential biomarkers including alarmins, cytokines, adipocytokines and growth factors, humoral innate immune and neuroendocrine molecules and regulators of iron metabolism. Biomarkers at hospital admission together with age, degree of hypoxia, neutrophil to lymphocyte ratio (NLR), lactate dehydrogenase (LDH), C-reactive protein (CRP) and creatinine were analysed within a data-driven approach to classify patients with respect to survival and ICU outcomes. Classification and regression tree (CART) models were used to identify prognostic biomarkers. Results Among the fifty-three potential biomarkers, the classification tree analysis selected CXCL10 at hospital admission, in combination with NLR and time from onset, as the best predictor of ICU transfer (AUC [95% CI] = 0.8374 [0.6233–0.8435]), while it was selected alone to predict death (AUC [95% CI] = 0.7334 [0.7547–0.9201]). CXCL10 concentration abated in COVID-19 survivors after healing and discharge from the hospital. Conclusions CXCL10 results from a data-driven analysis, that accounts for presence of confounding factors, as the most robust predictive biomarker of patient outcome in COVID-19. Graphic abstract

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“…Suggested to be a consequence of systemic inflammation and/ or SARS-CoV-2-induced cell death, this state of lymphopenia, when combined with maintained or elevated neutrophil counts, results in an elevated neutrophil:lymphocyte ratio (NLR) (89,105). An increased NLR at hospital admission is emerging as a useful indicator of disease severity and a potential tool of diagnostic and prognostic utility (106,107). For example, significantly higher baseline NLR values have been measured in COVID-19 patients who develop severe/critical disease when compared to mild or moderate cases (51,90,92,95,(108)(109)(110)(111), with this elevation persisting for up to 15 days post-hospital admission (51,100,112).…”

Section: Non-human Primatesmentioning

confidence: 99%

Neutrophils and COVID-19: Active Participants and Rational Therapeutic Targets

Hazeldine

Lord

2021

Front. Immunol.

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Whilst the majority of individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, experience mild to moderate symptoms, approximately 20% develop severe respiratory complications that may progress to acute respiratory distress syndrome, pulmonary failure and death. To date, single cell and high-throughput systems based analyses of the peripheral and pulmonary immune responses to SARS-CoV-2 suggest that a hyperactive and dysregulated immune response underpins the development of severe disease, with a prominent role assigned to neutrophils. Characterised in part by robust generation of neutrophil extracellular traps (NETs), the presence of immature, immunosuppressive and activated neutrophil subsets in the circulation, and neutrophilic infiltrates in the lung, a granulocytic signature is emerging as a defining feature of severe COVID-19. Furthermore, an assessment of the number, maturity status and/or function of circulating neutrophils at the time of hospital admission has shown promise as a prognostic tool for the early identification of patients at risk of clinical deterioration. Here, by summarising the results of studies that have examined the peripheral and pulmonary immune response to SARS-CoV-2, we provide a comprehensive overview of the changes that occur in the composition, phenotype and function of the neutrophil pool in COVID-19 patients of differing disease severities and discuss potential mediators of SARS-CoV-2-induced neutrophil dysfunction. With few specific treatments currently approved for COVID-19, we conclude the review by discussing whether neutrophils represent a potential therapeutic target for the treatment of patients with severe COVID-19.

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Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis

Cited by 142 publications

References 60 publications

Patients Admitted for Variant Alpha COVID-19 Have Poorer Outcomes than Those Infected with the Old Strain

Patients Admitted for Variant Alpha COVID-19 Have Poorer Outcomes than Those Infected with the Old Strain

CXCL10 levels at hospital admission predict COVID-19 outcome: hierarchical assessment of 53 putative inflammatory biomarkers in an observational study

Neutrophils and COVID-19: Active Participants and Rational Therapeutic Targets

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