The Prognostic Value of (NLR) Ratio in Patients with COVID-19

International Journal of Medical Science
© 2022 by SSRG - IJMS Journal
Volume 9 Issue 6
Year of Publication : 2022
Authors : Pauline Alkhoury, Malek Hejazie, Firas Hussain
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Pauline Alkhoury, Malek Hejazie, Firas Hussain, "The Prognostic Value of (NLR) Ratio in Patients with COVID-19," SSRG International Journal of Medical Science, vol. 9,  no. 6, pp. 1-10, 2022. Crossref, https://doi.org/10.14445/23939117/IJMS-V9I6P101

Abstract:

Coronavirus disease 2019, COVID-19, has worried the world since the beginning of its spread and posed a threat to public health. An elevated NLR is an independent risk factor for death in covid-19. This study aims to highlight the importance of the high NLR in predicting the severity of the disease and severe clinical outcomes. A cohort study included 203 patients diagnosed with COVID-19 by CT chest and swab positivity PCR technique. The primary follow-up endpoint considered death, and the secondary was the need for intensive care or invasive or non-invasive mechanical ventilation . We performed a cut-off ROC curve for the NLR to predict poor prognosis in COVID-19 patients regarding death, need for mechanical ventilation or intensive care . The NLR was statistically significantly higher in patients who died or required intensive care and mechanical ventilation compared with patients who did not require intensive care or survived. We found that age, smoking, ischemic heart disease, chronic lung disease, NLR and CURB 65 are statistically significant and independent factors in predicting the need for mechanical ventilation and the prognosis of death in patients with COVID . The most sensitive inflammatory indicator for predicting death was the NLR. The best cut-off point for the NLR was also determined. It is the point with the highest sensitivity and specificity for predicting a lousy prognosis, NLR = 9.5, where the sensitivity is 70% and the specificity is 65%.

Keywords:

Covid-19 disease, Neutrophils, Lymphocytes, Death, Mechanical ventilation, NLR.

References:

[1] Zhi-Yong Zeng, Shao-Dan Feng, Gong-Ping Chen and Jiang-Nan Wu, “Predictive Value of the Neutrophil to Lymphocyte Ratio for Disease Deterioration and Serious Adverse Outcomes in Patients with Covid-19: a Prospective Cohort Study,” BMC Infectious Diseases, vol. 21, no. 80, 2021.
[2] J. Fu, J. Kong, W. Wang, 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, vol. 192, pp. 3–8, 2020.
[3] D. Tatum, S. Taghavi, A. Houghton, et al, “Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana Covid-19 Patients,” Shock, vol. 54, no. 5, pp. 652–8, 2020.
[4] Mehr Muhammad Imran,Umair Ahmad,Umer Usman,Majid Ali,Aamir Shaukat and Noor Gul, “Retracted: Neutrophil/Lymphocyte Ratio—A Marker of COVID-19 Pneumonia Severity,” International Journal of Clinical Practice, vol. 75, no. 4, pp. e14151, 2021.
[5] C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu, et al, “Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China,” The Lancet, vol. 395, no. 10223, pp. 497–506, 2020.
[6] M. Fuad, Amaylia Oehadian, Delita Prihatni and Marthoenis, “Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-Based Severity at Admission,” Althea Medical Journal, vol. 8, no. 1, pp. 1–6, 2021.
[7] J. Zhang, M. Litvinova, W. Wang, et al, "Evolving Epidemiology and Transmission Dynamics of Coronavirus Disease 2019 Outside Hubei Province, China: a Descriptive and Modelling Study,” The Lancet Infectious Diseases, vol. 20, pp. 793-802, 2020. https://doi.org/10.1016/s1473-3099(20) 30230-9.
[8] Jun Fei, Lin Fu, Ying Li, Hui-Xian Xiang, Ying Xiang, Meng-Die Li, Fang-Fang Liu, De-Xiang Xu and Hui Zhao, “Reduction of Lymphocyte Count at Early Stage Elevates Severity and Death Risk of COVID-19 Patients: a Hospital-Based Case-Cohort Study,” Archives of Medical Science, DOI: https://doi.org/10.5114/aoms.2020.99006.
[9] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
[10] K. D. Pagana, T. J. Pagana and T. N. Pagana, “Mosby's Diagnostic and Laboratory Test Reference,” 14 ed. St. Louis, Elsevier, 2019.
[11] V. Brinkmann, U. Reichard, C. Goosmann, B. Fauler, Y. Uhlemann and D. S. Weiss, et al, “Neutrophil Extracellular Traps Kill Bacteria,” Science, vol. 303, pp. 1532–5, 2004. Doi: 10.1126/science.1092385.
[12] M. Scarsi, C. Zanotti, M. Chiarini, et al, “Reduction of Peripheral Blood T Cells Producing Ifn- Y and Il17 After Therapy with Abatacept for Rheumatoid Arthritis,” Clinical and Experimental Rheumatology, vol. 32, no. 2, pp. 204- 10, 2014.
[13] A. K. Abbas, A. H. Lichtman, “Cellular and Molecular Immunology,” 5th ed, Philadelphia, Saunders: Pp. 222-258, 2003.
[14] J. E. Berrington, D. Barge, A. C. Fenton, A. J. Cant and G. P. Spickett, “Lymphocyte Subsets In Term and Significantly Preterm UK Infants in the First Year of Life Analysed by Single-Platform Flow Cytometry,” Clin Exp Immunol, vol, 140, pp. 289-292, 2005. http://tiny.cc/o22l8y
[15] G. F. Sonnenberg and D. Artis, “Innate Lymphoid Cells in the Initiation, Regulation and Resolution of Inflammation,” Nat Med, vol. 21, pp. 698, 2015. doi: 10.1038/nm. 3892.
[16] C. Seillet and N. Jacquelot, “Sensing of physiological regulators by innate lymphoid cells,” cellular and molecular immunology, vol. 16, pp. 442–51, 2019. doi: 10.1038/s41423-019-0217-1
[17] M. Kondo, “Lymphoid and Myeloid Lineage Commitment in Multipotent Hematopoietic Progenitors,” Immunological Reviews, vol. 238, pp. 37-46, 2010. https://urlzs.com/ qHRW7
[18] Z. Xu, L. Shi, Y. Wang et al, “Pathological Findings of Covid-19 Associated with Acute Respiratory Distress Syndrome,” The Lancet Respiratory Medicine, vol. 8, no. 4, pp. 420–422, 2020.
[19] X. H. Yao, T. Y. Li, Z. C. He et al, “A Pathological Report of Three Covid-19 Cases by Minimal Invasive Autopsies,” Zhonghua Bing Li Xue Za Zhi, vol. 49, no. 5, pp. 411–417, 2020.
[20] N. Chen, M. Zhou, X. Dong et al, “Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: a Descriptive Study,” Lancet, vol. 395, no. 10223, pp. 507–513, 2020.
[21] P. E. Marik and E. Stephenson, “The Ability of Procalcitonin, Lactate, White Blood Cell Count and Neutrophil- Lymphocyte Count Ratio to Predict Blood Stream Infection. Analysis of a Large Database,” Journal of Critical Care, vol. 60, pp. 135–139, 2020. 
[22] Nico Reusch, Elena De Domenico, Lorenzo Bonaguro, Jonas Schulte-Schrepping, Kevin Baßler 1,2, Joachim L. Schultze, and Anna C. Aschenbrenner, “Neutrophils in COVID-19,” Front Immunol, 25 March 2021.
[23] SoheilTavakolpour, TahaRakhshandehroo, Erin X.Wei and Mohammad Rashidian, “Lymphopenia During the COVID-19 Infection: What it Shows and What Can be Learned,” Immunology Letters, vol. 225, pp. 31-32, 2020.
[24] Soheila Montazersaheb, Seyed Mahdi Hosseiniyan Khatibi, Mohammad Saeid Hejazi, Vahideh Tarhriz, Afsaneh Farjami, Faramarz Ghasemian Sorbeni, Raheleh Farahzadi, Tohid Ghasemnejad, Montazersaheb et al, “COVID-19 Infection: An Overview on Cytokine Storm and Related Interventions,” Virology Journal, vol. 19, no. 92, 2022.
[25] A. Yang, J. Liu, W. Tao and H. Li, “The Diagnostic and Predictive Role of NLR, d-NLR and PLR in COVID-19 Patients,” International Immunopharmacology, vol. 84, no. 106504, 2020. https://doi.org/10.1016/j.intimp.2020.106504
[26] H. Li, M. Zhao and Y. Xu, “Biochemical Analysis Between Common Type and Critical Type of COVID-19 and Clinical Value of Neutrophil/Lymphocyte Ratio,” Journal of Zhejiang University Medical Sciences, vol. 40, pp. 965-971, 2020.
[27] Q. Li, X. Guan, P. Wu, et al, “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia,” The New England Journal of Medicine, vol. 382, pp. 1199-1207, 2020. https://doi.org/10.1056/NEJMoa2001316
[28] G. Liu, S. Zhang, Z. Mao, W. Wang, and H. Hu, "Clinical Significance of Nutritional Risk Screening for Older Adult Patients With COVID-19," European Journal of Clinical Nutrition, vol. 74, no. 6, pp. 876 –883, 2020.
[29] W. Wei, X. Wu, C. Jin et al., "Predictive Significance of the Prognostic Nutritional Index (PNI) in Patients With Severe COVID-19," Journal of Immunology Research, 2021.