Role of Neutrophil Lymphocyte Ratio (NLR) in Predicting Disease Severity in Covid -19

Year 2022, , 6 - 12, 29.01.2022

Khadija Asif , Farhat Abbas

https://doi.org/10.46310/tjim.1011041

Cited By: 1

Abstract

Background: To evaluate the role of NLR as a prognostic indicator for severe COVID-19, due to its positive correlation with disease severity, easy accessibility and low cost.
Material and Methods: A multicenter retrospective observational study was conducted in COVID-19 wards of two tertiary care hospitals of Faisalabad city, Pakistan, treating COVID-19 patients between May 2021 - July 2021. A predesigned proforma was filled to collect the data. SPSS 21 was used for the statistical analysis of this research.
Results: A record of 100 COVID-19 patients admitted between May 2021 - July 2021, fulfilling the inclusion criteria was included in the study. All patients were divided into two groups. The non-severe group included 37 patients while the severe group included 63 patients. The mean age of the study population was 56 years with male predominance (63%). Overall, 50% of patients in the non-severe group and 71% in the severe group had some co-existent comorbidity. Fever and cough were the most commonly reported symptoms in both groups while shortness of breath was more widely reported in the severe group (74.2%). The mean NLR in the non-severe group was 4 as compared to 12 in the severe group.
Conclusions: Higher neutrophil lymphocyte ratio (NLR) is associated with severe COVID -19 and can be used as an effective tool to predict the progression of the non-severe disease to severe disease.

Keywords

Covid-19, Corona Virus, SARS- COV 2, Neutrophil/Lymphocyte ratio

References

• Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020 Oct;92(10):1733-4. doi: 10.1002/jmv.25819.
• COVID-19 coronavirus pandemic. https://www. worldometers.info/coronavirus/.
• Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497- 506. doi: 10.1016/S0140-6736(20)30183-5.
• World Health Organization, Clinical Management of Severe Acute Respiratory Infection When Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection is Suspected: Interim Guidance, World Health Organization, Geneva, 2019.
• Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-20. doi: 10.1056/ NEJMoa2002032.
• Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et. al.. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020 May;55:102763. doi: 10.1016/j.ebiom.2020.102763.
• Xia XY, Wu J, Liu HL, Xia H, Jia B, Huang WX. Epidemiological and initial clinical characteristics of p a t i e n t s w i t h fa m i l y a g g r e g a t i o n o f C O V I D -19. J C l i n V i r o l . 2020 Jun;127:104360. doi: 10.1016/j.jcv.2020.104360.
• Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, Zhang M, Tan J, Xu Y, Song R, Song M, Wang L, Zhang W, Han B, Yang L, Wang X, Zhou G, Zhang T, Li B, Wang Y, Chen Z, Wang X. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020 May 20;18(1):206. doi: 10.1186/s12967-020-02374-0.
• Kerboua KE. NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19. Immunol Invest. 2021 Jan;50(1):92-100. doi: 10.1080/08820139.2020.1773850.
• Shang W, Dong J, Ren Y, Tian M, Li W, Hu J, Li Y. The value of clinical parameters in predicting the severity of COVID-19. J Med Virol. 2020 Oct;92(10):2188-92. doi: 10.1002/jmv.26031.
• Sun S, Cai X, Wang H, He G, Lin Y, Lu B, Chen C, Pan Y, Hu X. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020 Aug;507:174-80. doi: 10.1016/j.cca.2020.04.024.
• Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020 Jul;84:106504. doi: 10.1016/j.intimp.2020.106504.
• Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020 May 5;172(9):577-82. doi: 10.7326/M20-0504.
• Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-42. doi: 10.1001/jama.2020.2648.
• Faria SS, Fernandes PC Jr, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, Eterovic AK, Forget P. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016 Dec 12;10:702. doi: 10.3332/ ecancer.2016.702.
• Chan AS, Rout A. Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19. J Clin Med Res. 2020 Jul;12(7):448-53. doi: 10.14740/jocmr4240.
• Meduri GU, Bridges L, Shih MC, Marik PE, Siemieniuk RAC, Kocak M. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med. 2016 May;42(5):829-40. doi: 10.1007/ s00134-015-4095-4.
• Xia H, Zhang Y, Deng W, Liu K, Xia X, Su CJ, Jeng US, Zhang M, Huang J, Huang J, Yan C, Wong WY, Lu X, Zhu W, Li G. Novel oligomer enables green solvent processed 17.5% ternary organic solar cells: synergistic energy loss reduction and morphology fine-tuning. Adv Mater. 2022 Jan 7:e2107659. doi: 10.1002/adma.202107659.
• Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umberger R. . Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest. 2007 Apr;131(4):954-63. doi: 10.1378/chest.06-2100.
• Ciccullo A, Borghetti A, Zileri Dal Verme L, Tosoni A, Lombardi F, Garcovich M, Biscetti F, Montalto M, Cauda R, Di Giambenedetto S; GEMELLI AGAINST COVID Group. Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line. Int J Antimicrob Agents. 2020 Aug;56(2):106017. doi: 10.1016/j.ijantimicag.2020.106017.