Differential White Blood Cell Count and COVID-19 Hospital Length of Stay: A Post-hoc Analysis

Gita Fajri Gustya, Darrin Ananda Nugraha, Muhammad Ilham Dhiya Rakasiwi, Farchan Azzumar, Erlina Burhan

Abstract


Objective: To explore the association between differential white blood cell count and hospital length of stay (LOS) in COVID-19 patients.

Methods: This study is a post-hoc analysis of two prospective cohort studies involving hospitalized COVID-19 patients who received standard therapy, including antiviral and supportive treatments at Persahabatan Hospital, Jakarta, Indonesia, during the Delta and Omicron dominant pandemic periods. Baseline differential white blood cell count before initiation of therapy were documented. LOS was categorized as ≤10 days and >10 days.

Result: Data from 463 subjects were included with most subjects were males (62.2%) with a median age of 54 (14–93) years. The average LOS for subjects was 12.7 (12.1–13.4) days. Bivariate tests showed that lymphocytes, neutrophils, monocytes, neutrophil-lymphocyte ratio (NLR), and neutrophil-monocyte ratio (NMR) had significant association (p <0.05) to LOS. Logistic regression showed that higher monocyte counts were associated with shorter LOS (adjusted OR 0.89; 95% CI 0.840 - 0.943; p < 0.001). ROC curve showed that higher monocyte counts (>8.35 × 10^3/µL) at admission may predict shorter hospitalization (<10 days).

Conclusion: Monocyte count may serve as a potential marker for length of stay in COVID-19 patients, offering key insights for optimizing patient management and resource allocation.


Keywords


COVID-19, length of stay, monocyte, neutrophil, risk factor

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References


  1. Setiadi W, Rozi IE, Safari D, Daningrat WOD, Johar E, Yohan B, et al. Prevalence and epidemiological characteristics of COVID-19 after one year of pandemic in Jakarta and neighbouring areas, Indonesia: A single center study. PLoS One. 2022;17(5):e0268241. DOI: 10.1371/journal.pone.0268241
  2. Mahendradhata Y, Andayani NLPE, Hasri ET, Arifi MD, Siahaan RGM, Solikha DA, et al. The capacity of the Indonesian Healthcare system to respond to COVID-19. Front public Heal. 2021 ;9. DOI: 10.3389/fpubh.2021.649819
  3. Arabi M, Al-Najjar Y, Mhaimeed N, Salameh MA, Paul P, AlAnni J, et al. Severity of the Omicron SARS‐CoV‐2 variant compared with the previous lineages: A systematic review. J Cell Mol Med. 2023;27(11):1443. DOI: 10.1111/jcmm.17747
  4. Tobin RJ, Wood JG, Jayasundara D, Sara G, Walker CR, Martin GE, et al. Real-time analysis of hospital length of stay in a mixed SARS-CoV-2 omicron and delta epidemic in New South Wales, Australia. BMC Infect Dis. 2023;23(1). DOI: 10.1186/s12879-022-07971-6
  5. Hajjar LA, Costa IBS da S, Rizk SI, Biselli B, Gomes BR, Bittar CS, et al. Intensive care management of patients with COVID-19: a practical approach. Ann Intensive Care. 2021;11(1). DOI: 10.1186/s13613-021-00820-w
  6. Nitsure M, Sarangi B, Shankar GH, Reddy VS, Walimbe A, Sharma V, et al. Mechanisms of Hypoxia in COVID-19 Patients: A Pathophysiologic Reflection. Indian J Crit Care Med. 2020;24(10):967–70. DOI: 10.5005/jp-journals-10071-23547
  7. Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. Conceptions of the pathophysiology of happy hypoxemia in COVID-19. Respir Res. 2021;22(1). DOI: 10.1186/s12931-021-01614-1
  8. Anurag A, Jha PK, Kumar A. Differential white blood cell count in the COVID-19: A cross-sectional study of 148 patients. Diabetes Metab Syndr. 2020;14(6):2099. DOI: 10.1016/j.dsx.2020.10.029
  9. Özdemir S, Eroğlu SE, Algın A, Akça HŞ, Özkan A, Pala E, et al. Analysis of laboratory parameters in patients with COVID-19: Experiences from a pandemic hospital Laboratory parameters of COVID-19. Ann Clin Anal Med. 2021;12(Suppl_04):518–23. DOI: 10.4328/ACAM.20678
  10. Nizami DJ, Raman V, Paulose L, Hazari KS, Mallick AK. Role of laboratory biomarkers in assessing the severity of COVID-19 disease. A cross-sectional study. J Fam Med Prim Care. 2021;10(6):2209. DOI: 10.4103/jfmpc.jfmpc_145_21
  11. Srinivas TR, Ho B, Kang J, Kaplan B. Post hoc analyses: after the facts. Transplantation. 2015;99(1):17–20. DOI: 10.1097/TP.0000000000000581
  12. Burhan E, Syahruddin E, Isbaniah F, Desianti GA, Fachrucha F, Sari CYI, et al. Evaluation of safety and effectiveness of remdesivir in treating COVID-19 patients after emergency use authorization study. Front Pharmacol. 2023;14. DOI: 10.3389/fphar.2023.1205238
  13. Sadeghi F, Halaji M, Shirafkan H, Pournajaf A, Ghorbani H, Babazadeh S, et al. Characteristics, outcome, duration of hospitalization, and cycle threshold of patients with COVID-19 referred to four hospitals in Babol City: a multicenter retrospective observational study on the fourth, fifth, and sixth waves. BMC Infect Dis. 2024;24(1):1–14. DOI:10.1186/s12879-023-08939-w
  14. Iwamoto S, Muhar BK, Chen H, Chu H, Johnstone M, Sidhu A, et al. Different COVID-19 treatments’ impact on hospital length of stay. Eur J Med Res. 2023;28(1):1–10. DOI: 10.1186/s40001-023-01201-8
  15. Menéndez R, Ferrando D, Vallés JM, Martínez E, Perpiñá M. Initial risk class and length of hospital stay in community-acquired pneumonia. Eur Respir J. 2001;18(1):151–6. DOI: 10.1183/09031936.01.00090001
  16. Suter-Widmer I, Christ-Crain M, Zimmerli W, Albrich W, Mueller B, Schuetz P, et al. Predictors for length of hospital stay in patients with community-acquired Pneumonia: Results from a Swiss Multicenter study. BMC Pulm Med. 2012;12:21. DOI: 10.1186/1471-2466-12-21
  17. Burhan E, Dwi Susanto A, Isbaniah F, Aman Nasution S, Ginanjar E, Wicaksono Pitoyo C, et al. Guidelines for the management of COVID-19 [in Indonesian]. 4th Ed. Indonesian Medical Association, editor. Jakarta; 2022.
  18. Frater JL, Zini G, d’Onofrio G, Rogers HJ. COVID-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42(S1):11–8. DOI: 10.1111/ijlh.13229
  19. Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5(1):33. DOI: 10.1038/s41392-020-0148-4
  20. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020395(10229):1054–62. DOI: 10.1016/S0140-6736(20)30566-3
  21. Zhao Y, Nie HX, Hu K, Wu XJ, Zhang YT, Wang MM, et al. Abnormal immunity of non-survivors with COVID-19: predictors for mortality. Infect Dis Poverty. 2020;9(1):108. DOI: 10.1186/s40249-020-00723-1
  22. 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;55:102763. DOI: 10.1016/j.ebiom.2020.102763
  23. Ravkov E V., Williams ESCP, Elgort M, Barker AP, Planelles V, Spivak AM, et al. Reduced monocyte proportions and responsiveness in convalescent COVID-19 patients. Front Immunol. 2023;14:1329026. DOI: 10.3389/fimmu.2023.1329026
  24. Kilercik M, Demirelce Ö, Serdar MA, Mikailova P, Serteser M. A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients. PLoS One. 2021;16(8):e0254073. DOI: 10.1371/journal.pone.0254073
  25. Isbaniah F, Juliani T, Damayanti T, Yenita D, Yunus F, Antariksa B, et al. The Role of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), and D-Dimer in Predicting the Outcome of Confirmed COVID-19 patients. J Respirologi Indones. 2021;41(4):236–44. DOI: 10.36497/jri.v41i4.215
  26. 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;92(10):1733. DOI: 10.1002/jmv.25819




DOI: https://doi.org/10.15850/ijihs.v12.n2.3915

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