COVID-19’lu Yatan Hastalarda Nötrofil/Lenfosit Oranı, Lenfosit/Monosit Oranı, Platelet/Lenfosit Oranı ve Hematolojik Parametrelerin Hastalığın Şiddet ve Prognozu ile İlişkisi

Abstract

Amaç: Hastanede yatan COVID-19’lu hastalarda nötrofil/lenfosit oranı (NLR), lenfosit/monosit oranı (LMR), platelet/lenfosit oranı (PLR) ve hematolojik parametrelerin hastalığın şiddeti ve prognozunu belirlemedeki değerini araştırmaktır. Materyal ve Metot: Çalışma bir göğüs hastalıkları kliniğinde Nisan-Eylül 2020 tarihleri arasında COVID-19 nedeniyle yatan 182 hasta ve 91 kontrol grubu ile retrospektif olarak gerçekleştirildi. Takipte hematolojik parametreler ile diğer parametreler arasındaki ilişki ve farklılıklar araştırıldı. Bulgular: Lenfosit, monosit, eozinofil, bazofil, hemoglobin, trombosit ve LMR anlamlı olarak daha düşüktü. NLR ve PLR daha yüksekti. Taburcu aşamasında, hematolojik parametreler ve PLR’de anlamlı artış bulundu. Radyolojik pnömoni şiddet skoru ile NLR (r=0.234, p=0.001) ve PLR (r=0.128, p=0.042) arasında anlamlı pozitif korelasyon ve LMR ile anlamlı ters korelasyon (r=-0.206, p=0.003) vardı. NLR (r=0.140, p=0.030) ve PLR (r=0.125, p=0.046) ile semptom-taburcu süresi arasında pozitif yönlü, LMR ile hem semptom-taburcu (r=-0.137, p=0.032) hem de hastanede kalış süresi (r=-0.135, p=0.034) arasında ters yönlü korelasyon tespit edildi. Hastaneye kabul ve taburculukta CRP ile NLR ve PLR arasında da pozitif bir korelasyon vardı. Sonuç: NLR, LMR ve PLR, COVİD-19’lu hastalarda hastalığın takibinde CRP’yle birlikte kullanılabilecek, hastalığın şiddetiyle anlamlı korelasyon gösteren, tedaviye yanıtı izlemede ve prognozu öngörmede faydalanılabilecek hematolojik prediktörler olarak bulunmuştur.

Keywords

• COVİD-19
• nötrofil lenfosit oranı
• lenfosit monosit oranı
• platelet lenfosit oranı
• radyolojik pnömoni şiddet skoru

The Association of Neutrophil/Lymphocyte Ratio, Lymphocyte/Monocyte Ratio, Platelet/Lymphocyte Ratio and Hematological Parameters with Severity and Prognosis in Hospitalized Patients with COVID-19

Abstract

Objective: To investigate neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR), platelet/lymphocyte (PLR) ratios, and the value of these parameters in determining disease severity and progression in hospitalized COVID-19 patients. Materials and Methods: Study was conducted retrospectively with 182 in-patients and 91 controls due to COVID-19 between April-September 2020 in the chest diseases clinic. Hematological parameters and rates were compared with controls’ parameters. Correlations and differences between hematological parameters and other parameters were investigated. Results: Lymphocyte, monocyte, eosinophil, basophil, hemoglobin, thrombocyte, and LMR were significantly lower. NLR and PLR were higher. There were significant increases in hematological parameters and PLR on discharge. A positive correlation existed between radiological pneumonia severity score, and NLR (r=0.234, p=0.001) and PLR (r=0.128, p=0.042), and significant inverse correlation with LMR (r=-0.206, p=0.003). Positive correlations were detected between NLR (r=0.140, p=0.030) and PLR (r=0.125, p=0.046), and symptom-discharge time, and inverse correlation between LMR, and both symptom-discharge (r=-0.137, p=0.032) and hospital stay time (r=-0.135, p=0.034). A positive correlation existed between CRP, and NLR and PLR on admission and discharge. Conclusion: NLR, LMR and PLR were found as hematological predictors to be used with CRP in following-up COVID-19, showing a significant correlation with disease severity, monitoring responses to treatment and predicting prognosis.

Keywords

• COVID-19
• neutrophil lymphocyte ratio
• lymphocyte monocyte ratio
• platelet lymphocyte ratio
• radiological pneumonia severity score

References

1. Adhikari SP, Meng S, Wu Y-J, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious diseases of poverty. 2020;9(1):1-12.
2. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733.
3. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
5. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
6. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-1069.
7. Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. Journal of Translational Medicine. 2020;18:1-12.
8. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-768.

9. Ying H, Deng Q, He B, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Medical Oncology (Northwood, London, England). 2014;31(12):305-305.
10. Chan AS, Rout A. Use of Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12(7):448-453.
11. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202-207.
12. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407-4416.
13. Wang H, Xing Y, Yao X, et al. Retrospective study of clinical features of COVID-19 in inpatients and their association with disease severity. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2020;26:e927674-e927674.
14. Asghar MS, Khan NA, Haider Kazmi SJ, et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J Community Hosp Intern Med Perspect. 2020;10(6):514-520.
15. Ufuk F, Demirci M, Sagtas E, Akbudak I, Ugurlu E, Sari T. The prognostic value of pneumonia severity score and pectoralis muscle Area on chest CT in adult COVID-19 patients. European Journal of Radiology. 2020;131:109271-109271.
16. Mousavi SA, Rad S, Rostami T, et al. Hematologic predictors of mortality in hospitalized patients with COVID-19: a comparative study. Hematology. 2020;25(1):383-388.
17. Rees EM, Nightingale ES, Jafari Y, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC medicine. 2020;18(1):1-22.
18. Rosenthal N, Cao Z, Gundrum J, Sianis J, Safo S. Risk factors associated with in-hospital mortality in a US national sample of patients with COVID-19. JAMA network open. 2020;3(12):e2029058-e2029058.
19. Gandhi RT, Lynch JB, Del Rio C. Mild or moderate COVID-19. N Engl J Med. 2020;383(18):1757-1766.