The role of neutrophil-lymphocyte ratio and lymphocyte–monocyte ratio in the prognosis of type 2 diabetics with COVID-19

Liu, Gaoli; Zhang, Shaowen; Hu, Haiquan; Liu, Tingting; Huang, Jie

doi:10.1177/0036933020953516

Cited by 37 publications

(30 citation statements)

References 27 publications

(30 reference statements)

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“…A lower ratio of circulating lymphocytes to monocytes (LMR) predicts severe and extremely severe COVID-19 as the clearance of the virus is delayed due to lymphopenia and also a decrease in CD4+ T cells. Both a rise or fall in lymphocyte levels is an extremely crucial prognostic indicator of mortality in COVID-19 [6].…”

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confidence: 99%

Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19

Bg¹,

Gosavi²,

Rao³

et al. 2021

Cureus

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Background and objective Neutrophils are primarily responsible for activating the immune system, and systemic inflammation destroys CD4+ T lymphocytes and increases suppressor CD8+ T lymphocytes, thereby leading to an increased neutrophil-to-lymphocyte ratio (NLR). An increase in the apoptosis of lymphocytes leads to lymphopenia and elevated thrombopoietin (THPO) promotes megakaryocyte production. The reflections of these inflammatory changes can be vital in gauging the progression of the disease. This study aimed at examining the prognostic value of normal and derived neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and mean platelet volume (MPV)-to-platelet count ratios in patients with coronavirus disease 2019 (COVID-19). Methodology This was a retrospective cross-sectional study conducted in the wards of Chigateri General Hospital, Davangere for a period of two months. Complete blood count was ordered for all patients at the time of admission along with confirmation of the disease by reverse transcription-polymerase chain reaction (RT-PCR). Results The final study population consisted of 100 patients. The mean age of patients who survived (43 years) was significantly lower than the mean age of non-survivors (59.1 years), with a p-value of <0.001. NLR was raised in 60% of the population and was significantly higher in patients who survived the disease, with a p-value of 0.004. The platelet-to-lymphocyte ratio (PLR) also followed a similar trend with a p-value of 0.017. Even though the lymphocyte-to-monocyte ratio (LMR) also mimicked the trend, the statistical association was not significant (p-value: 0.09). The derived NLR and MPV-to-platelets ratios were not found to be significantly associated with mortality in this study. Discussion Younger patients had better clinical outcomes in our study population compared to the geriatric age group. A significant correlation between LMR and mortality was observed when a cutoff of 2.5 was considered as a differentiating benchmark. Conflicting trends were observed in NLR and PLR in our study; however, LMR was in accordance with most other studies. The phase that a patient is in with regard to the natural history of the disease also influences the blood cell ratios. Nonetheless, all three ratios can be used as crucial screening and prognostic tools as they are readily available with the help of a complete hemogram. This is an investigation modality that is widely accessible even in remote areas and resource-limited settings. Conclusion These hematological ratios can facilitate in categorizing the disease severity and progression in patients, thereby enabling us to make appropriate and informed clinical decisions. Since the second wave of the novel coronavirus is on the verge of arrival, it is imperative to channel resources for the patients early in their disease course to ultimately prevent complications and reduce mortality.

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confidence: 99%

Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19

Bg¹,

Gosavi²,

Rao³

et al. 2021

Cureus

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“…In healthy peripheral blood, neutrophil ranges from 50 to 75%, monocytes range from 1 to 8%, and lymphocytes range from 20 to 40% [47]. The relative proportions and expression of leukocyte subsets change with diseases [48][49][50]. Neutrophil is usually maintained by RBC lysis but depleted by PBMC isolation.…”

Section: Discussionmentioning

confidence: 99%

The effect of cell isolation methods on the human transcriptome profiling and microbial transcripts of peripheral blood

et al. 2021

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The expression of human and microbial genes serves as biomarkers for disease and health. Blood RNA is an important biological resource for precision medicine and translational medicine. However, few studies have assessed the human transcriptome profiles and microbial communities composition and diversity of peripheral blood from different cell isolation methods, which could affect the reproducibility of researches. We collected peripheral blood from three healthy donors and processed it immediately. We used RNA sequencing to investigate the effect of three leukocyte isolation methods including buffy coat (BC) extraction, red blood cell (RBC) lysis and peripheral blood mononuclear cell (PBMC) isolation with the comparison with whole blood (WB), through analyzing the sensitivity of gene detection, the whole transcriptome profiling and microbial composition and diversity. Our data showed that BC extraction with high globin mRNA mapping rate had similar transcriptome profiles with WB, while RBC lysis and PBMC isolation depleted RBCs effectively. With the efficient depletion of RBC and distinct compositions of leukocyte subsets, RNA-seq of RBC lysis and PBMC isolation uniquely detected genes from specific cell types, like granulocytes and NK cells. In addition, we observed that the microbial composition and diversity were more affected by individuals than isolation methods. Our results showed that blood cell isolations could largely influence the sensitivity of detection of human genes and transcriptome profile.

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“… The neutrophil–lymphocyte ratio (NLR) = neutrophil count/lymphocyte count [ 19 ]. The lymphocyte–monocyte ratio (LMR) = lymphocyte count/monocyte count [ 20 ]. …”

Section: Methodsmentioning

confidence: 99%

“…Third, it is possible to develop a novel prediction model of COVID-19 progression, which is superior to previously reported prediction models. In this cohort of 1234 patients with COVID-19, we aimed to (1) develop and validate a novel prediction model of COVID-19 progression; (2) validate previously reported prediction models, including the CALL score [ 16 ], CoLACD score [ 17 ], PH-COVID-19 score [ 18 ], neutrophil–lymphocyte ratio [ 19 ], and lymphocyte–monocyte ratio [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel Prediction Model of COVID-19 Progression: A Retrospective Cohort Study

Huang

Ling

et al. 2021

Infect Dis Ther

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Introduction Estimating the risk of disease progression is of utmost importance for planning appropriate setting of care and treatment for patients with coronavirus disease 2019 (COVID-19). This study aimed to develop and validate a novel prediction model of COVID-19 progression. Methods In total, 814 patients in the training set were included to develop a novel scoring system; and 420 patients in the validation set were included to validate the model. Results A prediction score, called ACCCDL, was developed on the basis of six risk factors associated with COVID-19 progression: age, comorbidity, CD4 + T cell count, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH). For predicting COVID-19 progression, the ACCCDL score yielded a significantly higher area under the receiver operating characteristic curve (AUROC) compared with the CALL score, CoLACD score, PH-COVID-19 score, neutrophil–lymphocyte ratio, and lymphocyte–monocyte ratio both in the training set (0.92, 0.84, 0.83, 0.83, 0.76, and 0.65, respectively) and in the validation set (0.97, 0.83, 0.83, 0.78, 0.74, and 0.60, respectively). Over 99% of patients with the ACCCDL score < 12 points will not progress to severe cases, and over 30% of patients with the ACCCDL score > 20 points will progress to severe cases. Conclusion The ACCCDL score could stratify patients with at risk of COVID-19 progression, and was useful in regulating the large flow of patients with COVID-19 between primary health care and tertiary centers.

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The role of neutrophil-lymphocyte ratio and lymphocyte–monocyte ratio in the prognosis of type 2 diabetics with COVID-19

Cited by 37 publications

References 27 publications

Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19

Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19

The effect of cell isolation methods on the human transcriptome profiling and microbial transcripts of peripheral blood

A Novel Prediction Model of COVID-19 Progression: A Retrospective Cohort Study

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