Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission

M. Fuad, Amaylia Oehadian, Delita Prihatni, Marthoenis Marthoenis

Abstract


Background: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.

Methods:  A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. 

Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p <0.001]. Covid-19 patients who died had a higher NLR than those who survived [10.88 (4.17–47.50, IQR 7.00–15.17) vs 6.15 (2.80–97.00, IQR 4.63–8.50), p 0.02]. Patients with moderate-severe symptoms had an initial NLR of 4.63–8.50 and decreased to 2.75–5.43 at the end of the treatment had a greater chance of survival. There was an increased probability of death in patients with moderate-severe symptoms whose initial NLR was 7.00–15.17, which was then elevated to 14.33–23.25.

Conclusion: Different NLR at admission is seen among Covid-19 patients with mild and moderate-severe symptoms, leading to significantly different outcomes. The NLR can be used as a simple parameter to determine the severity of the disease and predict the outcome of Covid-19 patients.


Keywords


Covid-19, neutrophil-to-lymphocyte ratio, symptoms severity

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References


World Health Organization. Coronavirus disease (COVID-19) pandemic [Internet]. Geneva: Wold Health Organization; 2020 [cited 2020 Dec 28]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Kementerian Kesehatan Republik Indonesia. Situasi terkini perkembangan (COVID-19) [Internet]. Jakarta: Kemenkes RI; 2020 [cited 2020 Dec 28]. Available from: https://www.kemkes.go.id/index.php

Dinas Kesehatan Pemerintah Aceh. Data Covid-19 Aceh [Internet]. Dinkes Aceh; 2020 [cited 2020 Dec 28]. Available from: https://dinkes.acehprov.go.id/

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6–12.

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.

Wang S, Fu L, Huang K, Han J, Zhang R, Fu Z. Neutrophil-to-lymphocyte ratio on admission is an independent risk factor for the severity and mortality in patients with coronavirus disease 2019. J Infect. 2020; S0163-4453(20)30630-7.doi:10.1016/j.jinf.2020.09.022

Biswas PS, Sen D, Homchoudhary A, Makkar D, Kapoor M, Goyal A. Association of demographic, clinical, laboratory, and radiological characteristics with outcomes of COVID-19 patients: A systematic review and Meta-analysis. J Microbiol Infect Dis. 2019;9(3):121–35.

Rizo-Téllez SA, Méndez-García LA, Flores-Rebollo C, Alba-Flores F, Alcántara-Suárez R, Manjarrez-Reyna AN, et al. The neutrophil-to-monocyte ratio and lymphocyte-to-neutrophil ratio at admission predict in-hospital mortality in mexican patients with severe sars-cov-2 infection (Covid-19). Microorganisms. 2020;8(10):1560.

Moradi EV, Teimouri A, Rezaee R, Morovatdar N, Foroughian M, Layegh P, et al. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. Am J Emerg Med. 2021;40:11-14.

Lian J, Jin C, Hao S, Zhang X, Yang M, Jin X, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: A multicenter retrospective study. Aging (Albany NY). 2020;12(14):13849–59.

Xu J, Xu C, Zhang R, Wu M, Pan C, Li X, et al. Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China. Sci Rep. 2020;10(1):15058

Imran MM, Ahmed U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio – A marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021;2021:e13698. https://doi.org/10.1111/ijcp.13698

Pimentel GD, Dela Vega MCM, Laviano A. High neutrophil to lymphocyte ratio as a prognostic marker in COVID-19 patients. Clin Nutr ESPEN. 2020;40:101–2. Available from: https://doi.org/10.1016/j.clnesp.2020.08.004

Haghjooy Javanmard S, Vaseghi G, Manteghinejad A, Nasirian M. Neutrophil-to-Lymphocyte ratio as a potential biomarker for disease severity in COVID-19 patients. J Glob Antimicrob Resist. 2020;22:862–3. Available from: https://doi.org/10.1016/j.jgar.2020.07.029

Ministry of Health Republic of Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07-MENKES-413-2020 tentang Pedoman pencegahan dan pengendalian coronavirus disease 2019 (COVID–19). Jakarta; 2020. [Cited 2020 Dec 27] Available from: https://www.kemkes.go.id/resources/download/info-terkini/COVID-19 dokumen resmi/KMK No. HK.01.07-MENKES-413-2020 ttg Pedoman Pencegahan dan Pengendalian COVID-19.pdf

Mayer KP, Sturgill JL, Kalema AG, Soper MK, Seif SM, Cassity EP, et al. Recovery from COVID-19 and acute respiratory distress syndrome: The potential role of an intensive care unit recovery clinic: a case report. J Med Case Reports. 2020;14(1):161.

Möhlenkamp S, Thiele H. Ventilation of COVID-19 patients in intensive care units. Herz. 2020;45(4):329–31.

Sousa GJB, Garces TS, Cestari VRF, Florêncio RS, Moreira TMM, Pereira MLD. Mortality and survival of COVID-19. Epidemiol Infect. 2020;148:e123

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110–8. Available from: https://doi.org/10.1016/j.jaci.2020.04.006

Kerboua KE. NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19. Immunol Invest. 2020;00(00):1–9. Available from: https://doi.org/10.1080/08820139.2020.1773850




DOI: https://doi.org/10.15850/amj.v8n1.2255

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