Prognostic value of neutrophile-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) levels for geriatric patients with COVID-19

Önal, Uğur; Gülhan, Muhammet; Demirci, Neşe; Özden, Ahmet; Erol, Nazlı; Işık, Sema; GÜLTEN, Sedat; Atalay, Fatma; Çöplü, Nilay

doi:10.1186/s12877-022-03059-7

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…As it was expected [30,31] , there was highly significant correlation between plasma levels of CRP and AAT from COVID-19 patients (Fig 2A). Lower levels PaO2/FiO2 were negatively correlated with elevated levels of LDH which was reported previously as an indication of mortality rate [32,33] (Fig 2B). Consistent with previous reports, we also observed Higher levels of LDH in non-survivors compared with survivors (411.3±160.2, and 345.1±131.3, respectively) (Fig.…”

Section: Correlations Among Plasma Profiles In the Sars-cov2 Patientssupporting

confidence: 83%

Correlation of Alpha-1 Antitrypsin Levels and Exosome Associated Neutrophil Elastase Endothelial Injury in Subjects with SARS-CoV2 Infection

Lascano

Oshins

Eagan

et al. 2022

Preprint

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Background: Severe acute respiratory syndrome caused by a novel coronavirus 2 (SARS-CoV-2) has infected more than 18 million people worldwide. The activation of endothelial cells is a hallmark of signs of SARS-CoV-2 infection that includes altered integrity of vessel barrier and endothelial inflammation. Objectives: Pulmonary endothelial activation is suggested to be related to the profound neutrophil elastase (NE) activity, which is necessary for sterilization of phagocytosed bacterial pathogens. However, unopposed activity of NE increases alveolocapillary permeability and extracellular matrix degradation. The uncontrolled protease activity of NE during the inflammatory phase of lung diseases might be due to the resistance of exosome associated NE to inhibition by alpha-1 antitrypsin. Method: 31 subjects with a diagnosis of SARS-CoV2 infection were recruited in the disease group and samples from 30 voluntaries matched for age and sex were also collected for control. Results: We measured the plasma levels of exosome-associated NE in SARS-CoV-2 patients which, was positively correlated with the endothelial damage in those patients. Notably, we also found strong correlation with plasma levels of alpha-1 antitrypsin and exosome-associated NE in SARS-CoV-2 patients. Using macrovascular endothelial cells, we also observed that purified NE activity is inhibited by purified alpha-1 antitrypsin while, NE associated with exosomes are resistant to inhibition and show less sensitivity to alpha-1 antitrypsin inhibitory activity, in vitro. Conclusions: Our results point out the role of exosome-associated NE in exacerbation of endothelial injury in SARS-CoV-2 infection. We have demonstrated that exosome-associated NE could be served as a new potential therapeutic target of severe systemic manifestations of SARS-CoV-2 infection.

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Section: Correlations Among Plasma Profiles In the Sars-cov2 Patientssupporting

confidence: 83%

Correlation of Alpha-1 Antitrypsin Levels and Exosome Associated Neutrophil Elastase Endothelial Injury in Subjects with SARS-CoV2 Infection

Lascano

Oshins

Eagan

et al. 2022

Preprint

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“…In severe cases of COVID-19, viral attachment to lymphocytes, damage by inflammatory cytokines, migration, and aggregation to lung tissue are the causes of persistent decline in peripheral blood lymphocytes [ 31 ]. Decreased peripheral blood lymphocyte counts in COVID-19 patients have been widely reported as a risk factor for severe disease [ 9 , 13 , 31 ]. Our study showed that the effect of COVID-19 on lymphocytes was not attenuated on day 8, indicating that lymphopenia could be a major factor in predicting poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies have also focused on novel biomarkers, such as soluble urokinase receptors and C-reactive protein isoforms [ 10 , 11 ]. Clinical prediction tools combining these easily measurable but nonspecific laboratory markers have also been proposed [ 12 , 13 ]. Although they are useful in estimating the risk of resistance to treatment and mortality in COVID-19 patients, most are evaluated only during the initial visit or on admission.…”

Section: Introductionmentioning

confidence: 99%

Serum Lactate Dehydrogenase Level One Week after Admission Is the Strongest Predictor of Prognosis of COVID-19: A Large Observational Study Using the COVID-19 Registry Japan

Nakakubo

Unoki

Kitajima

et al. 2023

Viruses

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Clinical features of COVID-19 are diverse, and a useful tool for predicting clinical outcomes based on clinical characteristics of COVID-19 is needed. This study examined the laboratory values and trends that influence mortality in hospitalised COVID-19 patients. Data on hospitalised patients enrolled in a registry study in Japan (COVID-19 Registry Japan) were obtained. Patients with records on basic information, outcomes, and laboratory data on the day of admission (day 1) and day 8 were included. In-hospital mortality was set as the outcome, and associated factors were identified by multivariate analysis using the stepwise method. A total of 8860 hospitalised patients were included. The group with lactate dehydrogenase (LDH) levels >222 IU/L on day 8 had a higher mortality rate compared to the group with LDH levels ≤222 IU/L. Similar results were observed in subgroups formed by age, body mass index (BMI), underlying disease, and mutation type, except for those aged <50 years. When age, sex, BMI, underlying disease, and laboratory values on days 1 and 8 were tested for factors strongly associated with in-hospital mortality, LDH on day 8 was most strongly associated with mortality. LDH level on day 8 was the strongest predictor of in-hospital mortality in hospitalised COVID-19 patients, indicating its potential usefulness in post-treatment decision-making in severe COVID-19 cases.

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“…Neutrophil-lymphocyte ratio (NLR) is a systemic inflammatory marker used as a determinant of the diagnosis as well as prognosis of patients with a viral or bacterial infection. [13][14][15] Previous study has shown the importance of leukocyte kinetics, which is represented as NLR, in the first 3-5 days after hyperinflammation occurred. 13 "As a result, when compared to other inflammatory markers such as Procalcitonin and C-Reactive Protein, NLR proved to be a more rapid, feasible, cost-effective, and affordable marker that could be easily performed in any healthcare facility setting.…”

Section: Introductionmentioning

confidence: 99%

“…A previous study defined certain COV of NLR in COVID-19 patients but was dedicated to prognostic, disease severity, and mortality markers. 14,22,40 Therefore, the COV of NLR showed the other value to determine the occurrence of SPBI. A high prevalence ratio of NLR was also observed, indicating that a high NLR above the COV during the first three days is likely to suggest the presence of bacterial infection.…”

mentioning

confidence: 99%

The Diagnostic Value of Kinetics of NLR to Identify Secondary Pulmonary Bacterial Infection Among COVID-19 Patients at Single Tertiary Hospital in Indonesia

Sumardi¹,

Valentino²,

Prasetya³

et al. 2023

IJGM

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Coronavirus disease 2019 (COVID-19) is a new respiratory tract infection caused by severe acute respiratory syndrome coronavirus-2. The presence of secondary pulmonary bacterial infection (SPBI) made COVID-19 difficult to treat. Neutrophillymphocyte count ratio (NLR) is a systemic inflammatory marker used in the diagnosis and prognosis of viral or bacterial infection. At the first 3-5 days after hyperinflammation, it occurs in relation to clinical outcome. Therefore, this study aimed to evaluate the diagnostic value of NLR based on leukocyte kinetics upon admission and after 72 hours among COVID-19 patients with or without SPBI. Patients and Methods: This retrospective cross-sectional study analyzed medical records data of admitted patients with COVID-19 according to the International Classification of Disease 10th Revision (ICD-10) between January and December 2021. The list of patients was extracted and followed by a hand search to identify the inclusion or exclusion criteria and stratified into proven and nonproven SPBI based on clinical data. The study distinguished between SPBI by means of a cut-off value (COV) on the first (D1) and third day (D3), assessed using receiver operating characteristics (ROC), as well as determined the magnitude of sensitivity, specificity, and prevalence ratio. Results: A screening process was conducted on 2902 COVID-19 patients, of which 236 were included, accounting for 8.1%. Among these patients, 87 (36.9%) were found to have proven SPBI. A considerable difference in NLR value between proven and non-proven SPBI was observed on both D1 (11.1 vs 4.2) and D3 (15.3 vs 5.2), with optimal COV of NLR on D1, D3 was found to be 5.29, 9.47, respectively (p < 0.001). Conclusion: NLR on the D1 and D3 distinguished the occurrence of SPBI among COVID-19 patients. The application of NLR assisted in the early determination of bacterial infection and helped in controlling the empirical use of antibiotics.

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Prognostic value of neutrophile-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) levels for geriatric patients with COVID-19

Cited by 6 publications

References 20 publications

Correlation of Alpha-1 Antitrypsin Levels and Exosome Associated Neutrophil Elastase Endothelial Injury in Subjects with SARS-CoV2 Infection

Correlation of Alpha-1 Antitrypsin Levels and Exosome Associated Neutrophil Elastase Endothelial Injury in Subjects with SARS-CoV2 Infection

Serum Lactate Dehydrogenase Level One Week after Admission Is the Strongest Predictor of Prognosis of COVID-19: A Large Observational Study Using the COVID-19 Registry Japan

The Diagnostic Value of Kinetics of NLR to Identify Secondary Pulmonary Bacterial Infection Among COVID-19 Patients at Single Tertiary Hospital in Indonesia

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