Evaluation of NLR, d-NLR, and PLR in terms of disease severity in COVID-19 patients

Abstract

Some circulating biomarkers that may represent inflammation and immune status may be potential predictors for the prognosis of COVID-19 patients. Peripheral white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), derived NLR ratio [d-NLR, neutrophil count/(WBC count - neutrophil count)], and platelet-lymphocyte ratio (PLR) are useful biomarkers for the prognosis of patients with viral pneumonia. In this study, we aimed to evaluate the severity of the disease in COVID-19 patients using NLR, d-NLR, and PLR biomarkers. Patients who were followed up and treated with the diagnosis of COVID-19 for one year starting from April 2020 were included in the study. Patients with positive SARS-COV-2 PCR test or negative PCR results but with typical lung CT findings such as peripheral, bilateral, or multifocal round ground-glass opacity were included in the study if the clinical picture could not be explained by any other reason. According to the guidance of the World Health Organization (WHO) and the Ministry of Health of the Republic of Turkey, COVID-19 diagnosis and treatment guidelines, patients were grouped as severe and non-severe COVID-19. Of the 395 patients included, median age was 66.5% and 52.7% of the patients were female. Advanced age (<0.001), high d-NLR (0.027), and CRP (<0.001) levels were significantly associated with COVID-19 disease severity. Comorbidity, diabetes, heart disease, and COPD rates were statistically significantly higher in COVID-19 patients with severe disease (<0.001, 0.022, 0.004, and 0.027, respectively). NLR, d-NLR, and PLR values were higher in severe COVID-19 patients than in non-serious patients. Although our findings support the use of d-NLR levels in clinical practice, further studies should be developed to obtain a definitive consensus threshold.

Keywords

• COVID-19
• SARS-COV-2
• NLR
• d-NLR ve PLR

COVID-19 HASTALARINDA NLR, d-NLR VE PLR'NİN HASTALIK CİDDİYETİ AÇISINDAN DEĞERLENDİRİLMESİ*

Abstract

İnflamasyonu ve bağışıklık durumunu temsil edebilen dolaşımdaki bazı biyobelirteçler, COVID-19 hastalarının prognozu için potansiyel öngörücü olabilmektedir. Periferik beyaz kan hücresi (WBC) sayısı, nötrofil-lenfosit oranı (NLR), türetilmiş NLR oranı [d-NLR, nötrofil sayısı/ (WBC sayısı- nötrofil sayısı)] ve trombosit-lenfosit oranı (PLR) viral pnömonili hastaların prognozu için yararlı prediktör olarak sistematik inflamatuar cevabın göstergeleridir. Bu çalışmada COVID-19 hastalarında NLR, d-NLR ve PLR biyobelirteçleri kullanılarak hastalık ciddiyetinin değerlendirilmesi amaçlanmıştır. COVID-19 tanısıyla 2020 yılı Nisan ayından itibaren bir yıllık süreçte takip ve tedavileri yapılan hastalar çalışmaya alınmıştır. SARS-COV-2 PCR testi pozitif olan veya PCR sonuçları negatif olan ancak periferik, bilateral veya multifokal yuvarlak buzlu cam opasitesi gibi tipik Akciğer BT bulguları olan hastalar, klinik tablo başka bir nedenle açıklanamıyorsa çalışmaya dahil edilmiştir. Dünya Sağlık Örgütü (DSÖ) ve T.C. Sağlık Bakanlığı COVID-19 tanı ve tedavi kılavuzları rehberliğine göre hastalar ciddi ve ciddi olmayan COVID-19 olarak gruplanmıştır. Çalışmaya alınan 395 hastanın ortanca yaşı 66.5 idi ve %52.7’si kadındı. İleri yaş (<.001), yüksek d-NLR (0.027) ve CRP (<0.001) düzeyleri COVID-19 hastalık ciddiyeti ile önemli ölçüde ilişkiliydi. Komorbidite, diyabet, kalp hastalığı ve KOAH ciddi hastalık tablosu olan COVID-19 hastalarında istatistiksel olarak anlamlı derecede yüksek oranda izlendi (Sırasıyla <0.001, 0.022, 0.004 ve 0.027). Ciddi COVID-19 hastalarında, ciddi olmayan hasta grubuna göre NLR, d-NLR ve PLR değerleri daha yüksek seyretmiştir. Bulgularımız klinik pratikte d-NLR düzeylerinin kullanımını desteklemekle birlikte, kesin bir konsensüs eşik değeri elde etmek için daha ileri çalışmalar geliştirilmelidir.

Keywords

• COVID-19
• SARS-COV-2
• NLR
• d-NLR ve PLR

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