The correlation of neutrophil-to-lymphocyte ratio (NLR) and monocytes-to-lymphocytes ratio (MLR) with disease severity in hospitalized patients with Coronavirus disease 2019 (COVID-19)

Abstract

Background: Early intervention of cases with potential progression to severe disease is essential to improve survival probability in Coronavirus disease 2019 (COVID-19). Systemic inflammation plays an essential role in the process of disease aggravation. This study aimed to assess the correlation of systemic inflammatory response related biomarkers neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) on time to admission with the disease severity of inpatients with COVID-19.Methods: We performed a retrospective study using secondary data from medical records of inpatients with COVID-19 at Murni Teguh Memorial Hospital, Medan, Indonesia, from June 1 to September 30, 2020. The demographic data were collected from the medical record and the hematologic parameter from the laboratory. NLR and MLR were calculated by dividing the absolute neutrophils and monocytes counts by the absolute lymphocyte counts. The data were tabulated and analyzed by univariate and bivariate analysis with a significance level of p<0.05.Results: Study subjects consisted of 55 non-severe cases and 40 severe cases. The median NLR and MLR of severe and non-severe groups were 7.65 vs 2.92 (p<0.001) and 0.46 vs 0.25 (p=0.013). The correlation coefficients of NLR and MLR with disease severity were 0.564 (p<0.001) and 0.257 (p=0.012). The AUC of ROC analysis was 0.830 (cut-off:>4.81;p<0.001) in NLR and 0.650 (cut-off:>0.31; p=0.013) in MLR to predict the severe disease.Conclusion: NLR and MLR had a significant positive correlation with the disease severity. NLR is better than MLR in predicting severe disease in hospitalized patients with COVID-19.

Analisis Komparatif Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio dan Derived Neutrophil-to-Lymphocyte Ratio Terkait Derajat Keparahan COVID-19 pada Pasien Anak di Rumah Sakit Umum Daerah Ulin Banjarmasin

“…Beberapa studi terdahulu telah meneliti mengenai parameterparameter tersebut dalam peranannya sebagai prediktor mortalitas pada pasien dewasa, tetapi studi yang meneliti parameter tersebut sebagai prediktor mortalitas pada populasi anak masih sangat terbatas jumlahnya. [8][9][10][11]15 Berdasarkan analisis studi ini, tidak ditemukan perbedaan rerata NLR, PLR, MLR, dan dNLR antara kelompok anak dengan COVID-19 kasus severe dibandingkan non-severe. Hasil analisis menunjukkan adanya hubungan faktor komorbiditas lebih dari satu dan peningkatan LDH cenderung mengalami kasus COVID-19 severe.…”

“…18 Beberapa biomarker inflamasi dari pemeriksaan darah rutin terbukti dapat digunakan sebagai prediktor mortalitas pada pasien dewasa dengan COVID-19, diantaranya neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-tolymphocyte ratio (MLR) dan derived neutrophil-tolymphocyte ratio (dNLR), dan membandingkannya dengan parameter inflamasi C-reactive protein (CRP), laktat dehidrogenase (LDH), D-dimer, dan lain-lain. 8,9,14,15 Pada populasi anak dengan sepsis dan dalam kondisi perawatan intensif, NLR dan PLR juga dapat digunakan sebagai prediktor mortalitas, tetapi penggunaannya pada populasi anak dengan COVID-19 masih belum diketahui pasti. 10,11 Jumlah studi deskriptif dan analitik mengenai COVID-19 pada anak di Indonesia masih sangat terbatas.…”

Relationship Between Nlr, CRP and D-Dimer Level to Disease Severity in Covid-19 Patients Hospitalized in Wangaya Public Hospital

“…6 Bukti terkini mengimplikasikan bahwa neutrofil dan ketidakseimbangan antara pembentukan dan degradasi neutrophil extracellular trap (NET) memainkan peranan yang penting dalam patofisiologi inflamasi, koagulopati, kerusakan organ dan imunotrombosis yang khas pada kasus COVID-19 berat. 22 Efek proinflamasi dari NET adalah induksi interferon tipe 1 dan sitokin proinflamasi, peningkatan respon imun adaptif, kerusakan endotelium, dan imunotrombosis. Selain itu, agregasi NET dapat menyumbat berbagai organ dan memicu kerusakan organ.…”

Correlation of Interleukin-6 Level with Neutrophil to Lymphocyte Ratio and Disease Severity in COVID-19 Patients

“…About 10-20% of cases experience severe symptoms, characterized by the fast development of acute respiratory distress syndrome (ARDS), sepsis, and multiple organ failure. [2][3][4] COVID-2019 pathogenesis is not fully understood, and the basic mechanisms of clinical severity remain unclear. Recently, immune dysfunction that triggers a cytokine storm has been associated with rapid disease progression.…”

“…2 There is no specific examination as a severity predictor for patients, so it is necessary to find factors that can be used to estimate clinical severity in COVID-19 patients, which will signal when the patients meet the predictors of death so they will get the maximum treatment immediately. 4,7 Our research aims to investigate the immune-inflammatory markers in the peripheral blood of patients with various forms of COVID-19, then evaluate the correlation between serum interleukin-6 and NLR in predicting disease severity in COVID-19 patients.…”