Predictive Value of the Neutrophil-to-Lymphocyte Ratio(NLR) for Diagnosis and Worse Clinical Course of the COVID-19: Findings from Ten Provinces in China

Ma, Yan; Shi, Nannan; Fan, Yipin; Wang, Jingya; Zhao, Chen; Li, Guangxi; Zhang, Xiaofeng; Bai, Weiguo; Xiao, Fu-Rong; Wang, Jingwei; Na, Hui; Li, Quntang; Shi, Mei; Tang, Nong; Huang, Jingyue; Huang, Shaozhen; Huang, Jin; Jiang, Baihua; Xu, Hongming; Zhu, Tianqing; Xu, Shoufang; Xiao, Yanhua; Feng, Quanchen; Zhao, Shilei; Chen, Hong; Zhou, Yingchun; Liu, Zhang; Zhang, Huaben; Wang, Dongting; Wang, Yinzhen; Wang, Xiaoyan; Song, Fangli; Zheng, Kai; Wu, Lihui; Liu, Jinping; Hai-jun, Xie; Xue, Ruixia; Hu, Guifen; Ya, Mao; Zhang, Gongqi; Wu, Wei; Yang, Puye; Yang, Mei; Chen, Liying; Zhang, Jinbo; Guo, Tuanmao; Li, Yuanjun; Bai, Jiangfeng; Lei, Xiao; Li, Minqing; Zhang, Linsong; Zhu, Junteng; Sun, Sheng; Hu, Xiaomei; Hu, Yunhong; Yuan, Shengli; Lin, Tong; Liu, Sihong; Chen, Renbo; Shi, Zhan; Li, Li; Liu, Jia; Gu, Hao; Zhi, Yingjie; Wang, Zhifei; Li, Yuanyuan; Liang, Ning; Li, Huizhen; Jiao, Liwen; Huo, Ruili; Wang, Yongyan; Wang, Yanping; Zhang, Huamin; Wang, Wei

doi:10.2139/ssrn.3569838

Cited by 21 publications

(13 citation statements)

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“…In this study majority of individuals included in our study population reported ages above 50 years with a study population of 54 individuals comprising a majority of males. In our study, we detected elevated counts of neutrophils (neutrophilia) but in contrast, low lymphocyte counts (lymphopenia) thus resulting in an elevated ratio of neutrophil-tolymphocyte ratio in critically ill suffering for coronavirus disease 19 (COVID-19) coinciding with outcomes of several studies [6][7][8]11,[21][22][23][24][25]. In our study, we also detected significantly high counts of neutrophils and lowest counts of lymphocytes along with prominent elevation of neutrophil-tolymphocyte ratios among patients with refractory disease admitted to intensive care units and deceased patients when compared with patients in isolation wards and at initial phases of disease synchronizing with detections of numerous studies [6][7][8][21][22][23][24][25].…”

Section: Discussionsupporting

confidence: 58%

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Asghar

Khan

Kazmi

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Background and Objectives: COVID-19 is a global pandemic. In our study, we aimed to utilize the hematological parameters in predicting the prognosis and mortality in COVID-19 patients. Materials and methods: A retrospective, observational study was conducted to include all the admitted patients (n = 191) having COVID-19 Polymerase chain reaction (PCR) positive, and evaluated those for prognosis and disease outcome by utilizing several biochemical and hematological markers. Results: Amongst the patients admitted in the ward versus in the intensive care unit (ICU), there were significant differences in mean hemoglobin (P = 0.003), total leukocyte count (P = 0.001), absolute neutrophil and lymphocyte counts (P < 0.001), absolute monocyte count (P = 0.019), Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Monocyte ratio (LMR) (P < 0.001), Platelet-to-Lymphocyte ratio (PLR) and Lymphocyte-to C-reactive protein ratio (LCR) (P = 0.002), and C-reactive protein (CRP) levels (P < 0.001). Amongst the deceased patients, there was significant leukocytosis (P = 0.008), neutrophilia and lymphopenia (P < 0.001), increased NLR (P = 0.001), decreased LMR (P < 0.001), increased PLR (p = 0.017), decreased LCR (p = 0.003), and elevated CRP level (P < 0.001). A receiver operating characteristic curve obtained for the above parameters showed NLR (AUC: 0.841, PPV: 83.6%) and PLR (AUC: 0.703, PPV: 81.8%) for ICU patients, while NLR (AUC: 0.860, PPV: 91.1%) and PLR (AUC: 0.677, PPV: 87.5%) for the deceased patients had significant accuracy for predicting the disease severity of COVID-19 in comparison to survivors. Conclusion: The inflammatory markers and hematological indices are a good guide for predicting the severity and disease outcome of coronavirus disease. NLR and PLR are elevated in severe disease while LMR and LCR are inversely correlating with disease severity.

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Section: Discussionsupporting

confidence: 58%

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Asghar

Khan

Kazmi

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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“…[24][25][26][27] The results of several previous studies agree with the data reported here, showing that severe COVID-19 (including fatal cases) was associated with higher neutrophil counts and lower lymphocyte counts compared with mild or moderate COVID-19. [28][29][30] Wang and collaborators conducted a retrospective study of 131 patients with a median age of 64 years; among those patients, 12 (9.2%) died in hospital. Their study revealed that NLR on admission was significantly higher among non-survivors compared with survivors (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemoglobin level and neutrophil to lymphocyte ratio as prognostic markers in patients with COVID-19

et al. 2021

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Background Anemia can negatively affect the outcome of many diseases, including infections and inflammatory conditions. Aim To compare the prognostic value of hemoglobin level and the neutrophil/lymphocyte ratio (NLR) for prediction of coronavirus disease 2019 (COVID-19) severity. Methods In this retrospective cohort study, clinical data from patients with laboratory-confirmed COVID-19 were collected from hospital records from 10 April 2020 to 30 July 2020. Results The proportions of patients with mild, moderate, and severe COVID-19 differed significantly in association with hemoglobin levels, neutrophil counts, lymphocyte counts, NLR, and total leukocyte counts. Patients with severe COVID-19 had significantly lower hemoglobin levels than those with moderate or mild COVID-19. There were statistically significant negative associations between hemoglobin and D-dimer, age, and creatinine. The optimal hemoglobin cut-off value for prediction of disease severity was 11.6 g/dL. Using this cut-off value, hemoglobin had higher negative predictive value and sensitivity than NLR (92.4% and 51.3%, respectively). The specificity of hemoglobin as a prognostic marker was 79.3%. Conclusion Both NLR and hemoglobin level are of prognostic value for predicting severity of COVID-19. However, hemoglobin level displayed higher sensitivity than NLR. Hemoglobin level should be assessed upon admission in all patients and closely monitored throughout the disease course.

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“…There are many reasons for lymphopenia, such as IL-6, IL-10 or tumour necrosis factor (TNF). Dendritic cells and neutrophils also act indirectly to diminish lymphocytes [ 40 ]. Exaggerated activation of T cells or high-level expression of pro-apoptotic molecules is also likely to induce depletion of T cells [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19: captures iron and generates reactive oxygen species to damage the human immune system

Liu

2021

Autoimmunity

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Predictive Value of the Neutrophil-to-Lymphocyte Ratio(NLR) for Diagnosis and Worse Clinical Course of the COVID-19: Findings from Ten Provinces in China

Cited by 21 publications

References 0 publications

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Comparison of hemoglobin level and neutrophil to lymphocyte ratio as prognostic markers in patients with COVID-19

COVID-19: captures iron and generates reactive oxygen species to damage the human immune system

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