NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19

Kerboua, Kheir Eddine

doi:10.1080/08820139.2020.1773850

Cited by 51 publications

(41 citation statements)

References 41 publications

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“…Furthermore, NLR was found to be a prognostic factor for endotracheal intubation upon hospital admission and an independent predictor for risk of all-cause mortality during hospitalization 20,29 . The proposed optimum cut-off values to distinguish high NLR from low NLR ranged from 3 to 6 25 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Prozan¹,

Shusterman²,

Ablin³

et al. 2020

Preprint

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Background: A high Neutrophil to Lymphocyte Ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV).Method: A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. Results: 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P<0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.643, compared with 0.497 and 0.537 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 4.7) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 1.6, P=0.005). Conclusions: NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Prozan¹,

Shusterman²,

Ablin³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…1 SARS-CoV-2 controls either this cytokine production or other innate immune resistance like a fever to provoke a delayed overinflammation. 1,2 In this way, high levels of innate proinflammatory cytokine would be secreted in severe cases switching from protective to the destructive mechanism. 5 Thereafter, systemic inflammatory reaction associated with endothelial dysfunction might intensify disease severity resulting in hypercoagulability state and multiorgan failure.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Pathophysiologically, seminal reports show that SARS-CoV-2, during the asymptomatic replication phase, delays the inflammatory process by a few days, thus creating delayed exuberation of inflammation and rapid clinical deterioration in the second week. 1,2 As immunity functions according to two basic steps: recognition followed by an appropriate response, priming an individual necessitate to stimulate the same pathways of danger recognition; especially cytosolic PRR's in the case of SARS-CoV-2 infection. 5 Ultimately, we should focus more in training the cognitive part of innate immunity rather than the adaptive effector's components.…”

Section: Trained Immunitymentioning

confidence: 99%

“…It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that implies bidirectional control on innate-to-adaptive responses and backward to ensure high transmissibility and lethality. 1,2 During uncomplicated early stage, transmissibility is by doubling time every 3 days. 3 Indeed, common human coronaviruses are known to cause the common cold and mild upper respiratory infections in immunocompetent individuals and they progress to lower respiratory infections only in older or immunocompromised people.…”

Section: Introductionmentioning

confidence: 99%

“…As immunity functions into two basic steps: timely recognition followed by an appropriate response, SARS-CoV-2 evasion is mainly designed to circumvent cytosolic pathogen recognition receptors (PRR) to shut of immunity at the start of the infection and turn it against the host thereafter. 2,5 Similarly to children, it was hypothesized that resistance to SARS-CoV-2 infection may be due to some immune characteristic of the upper respiratory tract triggering a more active innate immune response to stop progression to pneumonia and severe illness. 4,6 Despite the reasons of such variability in the middle of this health emergency underway is very difficult to pin down, hypothetical explanations need to be tackled urgently to address both risk and protective factors to settle appropriate strategies to subdue this pandemic.…”

Section: Introductionmentioning

confidence: 99%

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The perplexing question of trained immunity vs adaptive memory in COVID‐19

Kerboua

2020

Journal of Medical Virology

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The wide spectrum of symptoms observed in coronavirus disease 2019 appears to defy explanation. Apart from geographic limitation to people with prior exposure to other coronaviruses and air pollutants, inflammatory comorbidities and older ages are also among the main factors of susceptibility to severe illness. The unusual epidemiological data pointed out in children and African territories have revealed new insights in host‐pathogen interplay with more focus on epigenetic regulation of cognitive compartments belonging to innate immunity. Should trained immunity be proven to be involved in timely immune responsiveness against severe acute respiratory syndrome coronavirus 2 and that adaptive memory could be detrimental, both treatment regimens and vaccine design will tremendously change accordingly with more focus on upper respiratory tissue innate immunity to subdue this threat underway.

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Hematological and Inflammatory Parameters to Predict the Prognosis in COVID-19

Hakan

2021

Indian J Hematol Blood Transfus

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We aimed to evaluate the predictive ability of hematological and inflammatory parameters for mortality in COVID-19 patients. This was a retrospective study of hospitalized COVID-19 patients over 18 years old between March 2020 and May 2020. Patients were diagnosed to have COVID-19 based either on chest computed tomography findings or reverse transcriptase-polymerase chain reaction test. Age, gender, chronic medical conditions, and laboratory values including hemogram parameters (white blood cell, neutrophil, lymphocyte, and platelet counts), neutrophil to lymphocyte ratio, D-dimer, ferritin, fibrinogen, C-reactive protein, procalcitonin, prothrombin time, activated partial thromboplastin time and the international normalized ratio were recorded. Overall, we included 302 patients. Of these, 148 patients were male; the male to female ratio was 0.961. The mean age of the entire study cohort was 57.1 ± 17.6 years. The most common chronic medical condition was hypertension (38.1%). Half of the patients received low molecular weight heparin. During the study period, 25 patients (8.2%) died. White blood cell count and neutrophil count were significantly higher, whereas lymphocyte count was significantly lower in the deceased patients. The median neutrophil to lymphocyte ratio was 11.6 in the deceased patients, it was significantly higher than the surviving patients ( p < 0.001). The values of C-reactive protein, procalcitonin, D-dimer, and ferritin were significantly higher among the deceased patients. Prothrombin time, activated partial thromboplastin time and the international normalized ratio were significantly longer in the deceased group compared with the surviving group. Logistic regression analysis showed age > 65 years, neutrophil to lymphocyte ratio, activated partial thromboplastin time, and hypertension as the independent predictors of mortality. The rate of abnormal inflammatory and hematologic-coagulation parameters increased with the COVID-19 severity. Age > 65 years, hypertension, activated partial thromboplastin time and neutrophil to lymphocyte ratio were the independent predictors of mortality.

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NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19

Cited by 51 publications

References 41 publications

Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

The perplexing question of trained immunity vs adaptive memory in COVID‐19

Hematological and Inflammatory Parameters to Predict the Prognosis in COVID-19

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