Predictive value of neutrophil-to-lymphocyte ratio for the fatality of COVID-19 patients complicated with cardiovascular diseases and/or risk factors

Abstract

Previous studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with disease severity and poor prognosis in COVID-19 patients. We aimed to investigate the clinical implications of NLR in patients with COVID-19 complicated with cardiovascular diseases and/or its risk factors (CVDRF). In total, 601 patients with known NLR values were selected from the CLAVIS-COVID registry for analysis. Patients were categorized into quartiles (Q1, Q2, Q3, and Q4) according to baseline NLR values, and demographic and clinical parameters were compared between the groups. Survival analysis was conducted using the Kaplan–Meier method. The diagnostic performance of the baseline and follow-up NLR values was tested using receiver operating characteristic (ROC) curve analysis. Finally, two-dimensional mapping of patient characteristics was conducted using t-stochastic neighborhood embedding (t-SNE). In-hospital mortality significantly increased with an increase in the baseline NLR quartile (Q1 6.3%, Q2 11.0%, Q3 20.5%; and Q4, 26.6%; p < 0.001). The cumulative mortality increased as the quartile of the baseline NLR increased. The paired log-rank test revealed significant differences in survival for Q1 vs. Q3 (p = 0.017), Q1 vs. Q4 (p < 0.001), Q2 vs. Q3 (p = 0.034), and Q2 vs. Q4 (p < 0.001). However, baseline NLR was not identified as an independent prognostic factor using a multivariate Cox proportional hazards regression model. The area under the curve for predicting in-hospital death based on baseline NLR was only 0.682, whereas that of follow-up NLR was 0.893. The two-dimensional patient map with t-SNE showed a cluster characterized by high mortality with high NLR at follow-up, but these did not necessarily overlap with the population with high NLR at baseline. NLR may have prognostic implications in hospitalized COVID-19 patients with CVDRF, but its significance depends on the timing of data collection.

Prognostic value of the neutrophil-to-lymphocyte ratio and C-reactive-protein-to-prealbumin ratio in hospitalized older patients with coronavirus disease 2019

“…These findings also suggest an imbalance between the innate immune response (neutrophils) and the adaptive immune response (lymphocytes), indicating increased inflammation and a weakened immune response. [17] Moreover, Higaki et al [18] demonstrated that elevated NLRs at follow-up are associated with increased mortality, emphasizing the dynamic nature of NLR as a response to treatment. Unlike our findings, this study revealed baseline NLR as an inadequate predictor of mortality.…”

Mortality in ICU COVID-19 Patients Is Associated with Neutrophil-to-Lymphocyte Ratio (NLR): Utility of NLR as a Promising Immunohematological Marker

“…Another study indicated a suitable value for NLR as a predictive marker for COVID-19 patients complicated with cardiovascular disorders. Results of their study showed that follow-up NLR had better overall predictive value, compared to baseline NLR, indicating the importance of time of sample collection for the prediction of mortality in complicated COVID-19 patients [26]. Also, in this regard, a multi-infammatory index along with CRP and NLR has been studied recently [27,28].…”

Predictive value of hematological indices on incidence and severity of pulmonary embolism in COVID‐19 patients

“…In addition, SARS‐CoV‐2‐infected T cells may also cause cytopathic effects on T cells. Therefore, the ratio of neutrophils to lymphocytes increases 18,24 . Even though the etiopathogenesis of PTE in COVID‐19 is not completely understood, factors related to the acute inflammatory response to the disease may be contributing to a dysregulation of the equilibrium of procoagulant and anticoagulant mechanisms.…”

“…Therefore, the ratio of neutrophils to lymphocytes increases. 18 , 24 Even though the etiopathogenesis of PTE in COVID‐19 is not completely understood, factors related to the acute inflammatory response to the disease may be contributing to a dysregulation of the equilibrium of procoagulant and anticoagulant mechanisms. Accordingly, it could reasonably be predicted that higher NLR values were also found in COVID‐19 patients with PTE when compared to patients with non‐PTE.…”