Prognostic Value of C-Reactive Protein to Lymphocyte Ratio (CLR) in Emergency Department Patients with SARS-CoV-2 Infection

Tonduangu, Ndenga; Borgne, Pierrick Le; Lefèbvre, François; Alamé, Karine; Bérard, Lise; Gottwalles, Y.; Cipolat, Lauriane; Gennai, Stéphane; Lavoignet, Charles-Éric; Vuillaume, Laure Abensur; Sepsis,

doi:10.3390/jpm11121274

Cited by 17 publications

(20 citation statements)

References 31 publications

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“…Similar to the study of Tonduangu et al ( 22 ) who reported higher values of CRP/Ly in severe clinical features group compared to the moderately ill group of patients (163.9 vs 83.0, p < 0.001), we noticed higher values of this HDR in a line with severity of the disease (61.49 vs 28.56, p < 0.001). The ratio was observed to have better sensitivity during the acute phase, but may be useful as a prognostic biomarker in predicting severity and mortality associated with COVID-19 infection ( 22 ). By reviewing the literature, we noticed that the ratio of lymphocytes and CRP was not given special attention.…”

Section: Discussionsupporting

confidence: 91%

The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

Šegalo¹,

Kiseljaković²,

Papic³

et al. 2023

Acta Inform Med

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Background: Coronavirus disease 2019 (COVID-19) can cause a wide clinical spectrum, ranging from asymptomatic to severe disease with a high mortality rate. In view of the current pandemic and the increasing influx of patients into healthcare facilities, there is a need to identify simple and reliable tools for stratifying patients. Objective: Study aimed to analyze whether hemogram-derived ratios (HDRs) can be used to identify patients with a risk of developing a severe clinical form and admission to hospital. Methods: This cross-sectional and observational study included 500 patients with a confirmed diagnosis of COVID-19. Data on clinical features and laboratory parameters were collected from medical records and 13 HDRs were calculated and analyzed. Descriptive and inferential statistics were included in the analysis. Results: Of the 500 patients, 43.8% had a severe form of the disease. Lymphocytopenia, monocytopenia, higher C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were found in severe patients (p < 0.05). Significantly higher neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), neutrophil-to-platelet ratio (NPR), neutrophil-to-lymphocyte-to-platelet ratio (NLPR) and CRP-to-lymphocyte ratio (CRP/Ly) values were found in severe patients (p < 0.001). In addition, they have statistically significant prognostic potential (p < 0.001). The area under the curve (AUC) for CRP/Ly, dNLR, NLPR, NLR, and NPR were 0.693, 0.619, 0.619, 0.616, and 0.603, respectively. The sensitivity and specificity were 65.7% and 65.6% for CRP/Ly, 51.6% and 70.8 for dNLR, 61.6% and 57.3% for NLPR, 40.6% and 80.4% for NLR, and 48.8% and 69.1% for NPR. Conclusion: The results of the study suggest that NLR, dNLR, CRP/Ly, NPR, and NLPR can be considered as potentially useful markers for stratifying patients with a severe form of the disease. HDRs derived from routine blood tests results should be included in common laboratory practice since they are readily available, easy to calculate, and inexpensive.

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Section: Discussionsupporting

confidence: 91%

The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

Šegalo¹,

Kiseljaković²,

Papic³

et al. 2023

Acta Inform Med

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“…Previous studies have shown that numerous diseases are associated with these inflammatory parameters. The acute intracerebral hemorrhage patients with higher MHR values were associated with an increased risk of disability or death according to research by Usta et al 12 Wang 32 and Tonduangu 34 also proved that NHR and CLR could predict the severity and mortality associated with SARS-CoV-2 infection. And CAR is an easily available and independent prognostic marker in locally advanced Non-Small Cell Lung Cancer after CRT.…”

Section: Discussionmentioning

confidence: 90%

“…Recently, monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophils to high-density lipoprotein cholesterol ratio (NHR), C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-to-albumin ratio (CAR) have attracted extensive attention. Elevated MHR, 12,28,29 NHR, [30][31][32] CLR, [33][34][35] and CAR [36][37][38] have been proved to be related to numerous disorders. However, to date, there is no literature on an association between MHR, NHR, CLR and CAR, and APTB-T2DM patients.…”

Section: Introductionmentioning

confidence: 99%

The Novel Predictive Biomarkers for Type 2 Diabetes Mellitus in Active Pulmonary Tuberculosis Patients

Yu¹,

Weng²,

Luo³

et al. 2022

IDR

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Purpose This study was to explore the predictive value of monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophils to high-density lipoprotein cholesterol ratio (NHR), C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-to-albumin ratio (CAR) for type 2 diabetes mellitus (T2DM) in patients with active pulmonary tuberculosis (APTB). Patients and Methods A total of 991 active pulmonary tuberculosis (APTB) patients (201 with T2DM) were hospitalized in the Department of Tuberculosis, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The routine blood examination indicators and biochemical parameters were collected to calculate MHR, NHR, CLR, and CAR. The Pearson correlation analysis, Univariate Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were performed to assess the predictive value of MHR, NHR, CLR, and CAR for APTB-T2DM patients. Results The levels of MHR, NHR, CLR, and CAR in the APTB-T2DM patients were significantly higher than in the APTB-no T2DM patients (P < 0.05). Additionally, the MHR, NHR, CLR, and CAR have a positive correlation with fasting blood glucose in the whole study population. However, in the APTB-T2DM patients, MHR, NHR, and CAR were not correlated with fasting blood glucose, and only CLR was positively correlated with fasting blood glucose. The area under curve (AUC) predicting APTB-T2DM patients of the MHR, NHR, CLR, and CAR was 0.632, 0.72, 0.715, and 0.713, respectively. Further, univariate logistic regression analyses showed that the higher MHR, NHR, CLR, and CAR were independent risk factors for APTB-T2DM (P < 0.01). The MHR, NHR, CLR, and CAR quartiles were used to divide the APTB patients into four groups for further analysis. The prevalence of T2DM was significantly higher in APTB individuals as MHR, NHR, CLR, and CAR values increased (P < 0.05). Conclusion MHR, NHR, CLR, and CAR are simple and practicable inflammatory parameters that could be used for assessing T2DM in APTB. APTB patients have a greater possibility to be diagnosed with T2DM with the higher MHR, NHR CLR, and CAR values. Therefore, more attention should be given to the indicator in the examination of APTB.

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“…A recent study showed that patients with NLR ≥ 2.6937 were at high risk with the potential to develop worsened and serious clinical outcomes [ 22 ]. In previous study, the cutoff value for CLR ≥ 78.3 can be regarded as patients with severe disease, and ≥ 159.5 can predict mortality [ 15 ]. Together with our study, the NLR and CLR showed the most consistent results across studies in predicting COVID-19 disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several emerging biomarkers such as neutrophil to lymphocyte ratio (NLR) [ 1 , 13 ], platelet to lymphocyte ratio (PLR) [ 14 ] and C-reactive protein to lymphocyte ratio (CLR) [ 15 ] were used to assess COVID-19 progression and were more specific in the early triage of admission than was routine laboratory testing [ 16 ]. Many patients with mild symptoms can potentially progress to severe or critical stages and have different management with oxygen support [ 3 ]; therefore, a simple and efficient predictor is vital to provide increased attention care to reduce the mortality of COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of emerging inflammatory markers for predicting oxygen support requirement in COVID-19 patients

et al. 2022

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Coronavirus disease 2019 (COVID-19), a highly contagious pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly and remains a challenge to global public health. COVID-19 patients manifest various symptoms from mild to severe cases with poor clinical outcomes. Prognostic values of novel markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein to lymphocyte ratio (CLR) calculated from routine laboratory parameters have recently been reported to predict severe cases; however, whether this investigation can guide oxygen therapy in COVID-19 patients remains unclear. In this study, we assessed the ability of these markers in screening and predicting types of oxygen therapy in COVID-19 patients. The retrospective data of 474 COVID-19 patients were categorized into mild and severe cases and grouped according to the types of oxygen therapy requirement, including noninvasive oxygen support, high-flow nasal cannula and invasive mechanical ventilator. Among the novel markers, the ROC curve analysis indicated a screening cutoff of CRP ≥ 30.0 mg/L, NLR ≥ 3.0 and CLR ≥ 25 in predicting the requirement of any type of oxygen support. The NLR and CLR with increasing cut-off values have discriminative power with high accuracy and specificity for more effective oxygen therapy with a high-flow nasal cannula (NLR ≥ 6.0 and CLR ≥ 60) and mechanical ventilator (NLR ≥ 8.0 and CLR ≥ 80). Our study thus identifies potential markers to differentiate the suitable management of oxygen therapy in COVID-19 patients at an earlier time for improving disease outcomes with limited respiratory support resources.

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Prognostic Value of C-Reactive Protein to Lymphocyte Ratio (CLR) in Emergency Department Patients with SARS-CoV-2 Infection

Cited by 17 publications

References 31 publications

The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

The Novel Predictive Biomarkers for Type 2 Diabetes Mellitus in Active Pulmonary Tuberculosis Patients

Evaluation of emerging inflammatory markers for predicting oxygen support requirement in COVID-19 patients

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