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Predictive role of NLR, SII, and PLR in COVID-19 patient mortality and disease severity

Yıl 2022, Cilt 3, Sayı 1, 43 - 50, 31.01.2022

Öz

Background: In this study, it was aimed to evaluate the factors affecting the prognosis and mortality of patients hospitalized for coronavirus disease 2019 (COVID-19).

Methods: Patients hospitalized with COVID-19 infection between March and November 2020 were examined retrospectively. The Systemic Immune-Inflammation Index (SII), platelet lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) values were evaluated for their effect on prognosis.

Results: Of the 1013 patients included in the study, 204 (20.1%) had a severe infection. In the multivariate analysis, it was determined that the prognosis was significantly worse in patients who were >65 years of age, had a Charlson Comorbidity Index (CCI) score of >2, and had a high NLR rate. The C-reactive protein (CRP), PLR, SII values were detected as insignificant variables. Mortality was found to be statistically significant in patients with a CCI score of 2 or more and in patients with high CRP, NLR, PLR, and SII values at the time of admission (p<0.05) in the multivariate analysis.

Conclusions: It was found that the most important factor affecting the severity of the disease was advanced age and high comorbidities, and a high NLR value. The most important prognostic factors affecting mortality were high levels of comorbidities, and high NLR, PLR, SII, and CRP values.

Kaynakça

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  • 2. Usul E, Şan İ, Bekgöz B, Şahin A. Role of hematological parameters in COVID-19 patients in the emergency room. Biomark Med. 2020;14(13):1207–15.
  • 3. Peng J, Qi D, Yuan G, Deng X, Mei Y, Feng L, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID‐19): A multicenter, cross‐sectional study. J Clin Lab Anal. 2020;34(10):e23475.
  • 4. 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;84:106504.
  • 5. Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475.
  • 6. Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, et al. The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules. 2020;25(23):5725.
  • 7. World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. 2019. Available at: https://apps.who.int/iris/ handle/10665/178529 Accessed February 11, 2020.
  • 8. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance. 2020. Available at: https://www.who.int/ publications/i/item/10665-331501 Accessed January 14, 2020.
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  • 10. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med. Elsevier; 2000;108:609–13.
  • 11. Duan J, Pan L, Yang M. Preoperative elevated neutrophil-tolymphocyte ratio (NLR) and derived NLR are associated with poor prognosis in patients with breast cancer: A meta-analysis. Medicine (Baltimore). 2018;97(49):e13340.
  • 12. Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to- Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017;111:176-181.
  • 13. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophilto- lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-e12.
  • 14. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res. 2020;192:3-8.
  • 15. Kalabin A, Mani VRK, Valdivieso SC, Donaldson B. Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients. Le Infez Med. 2021;29:46–53.
  • 16. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(6):355-362.
  • 17. Chan AS, Rout A. Use of neutrophil-to-lymphocyte and plateletto- lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12:448.
  • 18. Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58:1021–8.
  • 19. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934–43.
  • 20. Wang K, Chen W, Zhang Z, Deng Y, Lian JQ, Du P, et al. CD147- spike protein is a novel route for SARS-CoV-2 infection to host cells. Signal Transduct Target Ther. 2020;5(1):283.
  • 21. Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21:1–7.
  • 22. Liu YP, Li GM, He J, Liu Y, Li M, Zhang R, et al. Combined use of the neutrophil-to-lymphocyte ratio and CRP to predict 7-day disease severity in 84 hospitalized patients with COVID-19 pneumonia: a retrospective cohort study. Ann Transl Med. 2020;8(10):635.
  • 23. Qu R, Ling Y, Zhang Y, Wei L, Chen X, Li X, et al. Platelet‐tolymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. J Med Virol. 2020;92:1533–41.
  • 24. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: A metaanalysis. Int J Infect Dis. 2020;96:467-474.
  • 25. Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito NPH, et al. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med. 2021;41:110-119.
  • 26. Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, et al. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J community Hosp Intern Med Perspect. 2020;10:402–8.
  • 27. Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2015;53(9):e65-72.
  • 28. Imam Z, Odish F, Gill I, O’Connor D, Armstrong J, Vanood A, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID‐19 patients in Michigan, United States. J Intern Med. 2020;288:469–76.
  • 29. Kuswardhani RAT, Henrina J, Pranata R, Lim MA, Lawrensia S, Suastika K. Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and metaanalysis. Diabetes Metab Syndr Clin Res Rev. Elsevier; 2020;

Yıl 2022, Cilt 3, Sayı 1, 43 - 50, 31.01.2022

Öz

Kaynakça

  • 1. Ma X, Ng M, Xu S, Xu Z, Qiu H, Liu Y, et al. Development and validation of prognosis model of mortality risk in patients with COVID-19. Epidemiol Infect. 2020;148.
  • 2. Usul E, Şan İ, Bekgöz B, Şahin A. Role of hematological parameters in COVID-19 patients in the emergency room. Biomark Med. 2020;14(13):1207–15.
  • 3. Peng J, Qi D, Yuan G, Deng X, Mei Y, Feng L, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID‐19): A multicenter, cross‐sectional study. J Clin Lab Anal. 2020;34(10):e23475.
  • 4. 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;84:106504.
  • 5. Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475.
  • 6. Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, et al. The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules. 2020;25(23):5725.
  • 7. World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. 2019. Available at: https://apps.who.int/iris/ handle/10665/178529 Accessed February 11, 2020.
  • 8. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance. 2020. Available at: https://www.who.int/ publications/i/item/10665-331501 Accessed January 14, 2020.
  • 9. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. 2019. https://www.who.int/csr/ disease/ coronavirus_infections/InterimGuidance_ClinicalManage ment_ NovelCoronavirus_11Feb13u.pdf?ua=1&ua=1. Accessed February 11, 2020.
  • 10. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med. Elsevier; 2000;108:609–13.
  • 11. Duan J, Pan L, Yang M. Preoperative elevated neutrophil-tolymphocyte ratio (NLR) and derived NLR are associated with poor prognosis in patients with breast cancer: A meta-analysis. Medicine (Baltimore). 2018;97(49):e13340.
  • 12. Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to- Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017;111:176-181.
  • 13. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophilto- lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-e12.
  • 14. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res. 2020;192:3-8.
  • 15. Kalabin A, Mani VRK, Valdivieso SC, Donaldson B. Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients. Le Infez Med. 2021;29:46–53.
  • 16. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(6):355-362.
  • 17. Chan AS, Rout A. Use of neutrophil-to-lymphocyte and plateletto- lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12:448.
  • 18. Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58:1021–8.
  • 19. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934–43.
  • 20. Wang K, Chen W, Zhang Z, Deng Y, Lian JQ, Du P, et al. CD147- spike protein is a novel route for SARS-CoV-2 infection to host cells. Signal Transduct Target Ther. 2020;5(1):283.
  • 21. Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21:1–7.
  • 22. Liu YP, Li GM, He J, Liu Y, Li M, Zhang R, et al. Combined use of the neutrophil-to-lymphocyte ratio and CRP to predict 7-day disease severity in 84 hospitalized patients with COVID-19 pneumonia: a retrospective cohort study. Ann Transl Med. 2020;8(10):635.
  • 23. Qu R, Ling Y, Zhang Y, Wei L, Chen X, Li X, et al. Platelet‐tolymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. J Med Virol. 2020;92:1533–41.
  • 24. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: A metaanalysis. Int J Infect Dis. 2020;96:467-474.
  • 25. Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito NPH, et al. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med. 2021;41:110-119.
  • 26. Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, et al. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J community Hosp Intern Med Perspect. 2020;10:402–8.
  • 27. Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2015;53(9):e65-72.
  • 28. Imam Z, Odish F, Gill I, O’Connor D, Armstrong J, Vanood A, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID‐19 patients in Michigan, United States. J Intern Med. 2020;288:469–76.
  • 29. Kuswardhani RAT, Henrina J, Pranata R, Lim MA, Lawrensia S, Suastika K. Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and metaanalysis. Diabetes Metab Syndr Clin Res Rev. Elsevier; 2020;

Ayrıntılar

Birincil Dil İngilizce
Konular Tıp, Enfeksiyon Hastalıkları
Bölüm ORIGINAL ARTICLE
Yazarlar

Ayşegül İnci SEZEN (Sorumlu Yazar)
Health Sciences University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
0000-0001-8920-9019
Türkiye


Kadriye KART YAŞAR
Health Sciences University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
0000-0003-2963-4894
Türkiye

Destekleyen Kurum Yok
Proje Numarası Yok
Yayımlanma Tarihi 31 Ocak 2022
Başvuru Tarihi 14 Eylül 2021
Kabul Tarihi 25 Ekim 2021
Yayınlandığı Sayı Yıl 2022, Cilt 3, Sayı 1

Kaynak Göster

APA Sezen, A. İ. & Kart Yaşar, K. (2022). Predictive role of NLR, SII, and PLR in COVID-19 patient mortality and disease severity . Archives of Current Medical Research , 3 (1) , 43-50 . Retrieved from https://dergipark.org.tr/tr/pub/acmr/issue/68361/995628

Archives of Current Medical Research (ACMR) provides instant open access to all content, bearing in mind the fact that presenting research

free to the public supports a greater global exchange of knowledge.

http://www.acmronline.org/