DOI: http://dx.doi.org/10.18203/2349-3933.ijam20212756

Comparison of neutrophil-lymphocyte ratio among severe acute respiratory illness COVID-19 positive and negative patients and to correlate with disease severity

Guruprasad C. Shenoy, Madhumathi Ramaiah, Shreedevi Kamaraddi, Pallavi Somashekar, Sachin Katte Subramanya

Abstract


Background: COVID-19, a pandemic caused by SARS-CoV-2, has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Neutrophil-lymphocyte (NL) ratio is an indicator of systemic inflammatory response. Many previous studies have shown NL ratio to be good prognostic marker for COVID-19 pneumonia.

Methods: A study was conducted on 265 SARI (severe acute respiratory illness) patients who were admitted in hospitals attached to BMCRI between May 2020 and September 2020. History was taken, general and systemic examination was done. Patients were categorized into moderate and severe illness. RT-PCR for all patients was done using throat and nasal swab. Total WBC counts and differential counts were estimated. NL ratio was correlated with pneumonia severity and compared between COVID-19 positive and negative SARI.

Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. The patients were further sub-categorised into moderate and severe SARI. Mean age for COVID-19 positive severe SARI was higher than the moderate SARI. Males were majority of the subjects. Out of 265, 99 patients (37.4%) had diabetes. Out of this, 34 (42%) were COVID-19 positive (severe) followed by 28 (51.9%) COVID-19 positive (moderate). Mean NL ratio was higher in COVID-19 positive (severe) subjects 15.95±10.31 followed by COVID-19 positive (moderate) subjects 8.99±6.22. There was significant difference with respect to NL ratio between COVID-19 positive and negative subjects. NL ratio levels were high in subjects having diabetes in COVID-19 positive severe sub group and COVID-19 positive severe hypertension sub group as compared to other sub groups.

Conclusions: NL ratio was higher in patients with COVID-19 positive SARI as compared to COVID-19 negative SARI. There was significant correlation between increase in NL ratio and disease severity of COVID-19 positive pneumonia. We found that increase in NL ratio was associated with co-morbidities like diabetes mellitus and hypertension.


Keywords


COVID-19, SARI, Neutrophil-lymphocyte ratio

Full Text:

PDF

References


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. 2020;395(10229):1054-62.

Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020;54(5):652-8.

Sommerstein R, Fux CA, Vuichard-Gysin D, Abbas M, Marschall J, Balmelli C, et al. Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19. Antimicrob Resist Infect Control. 2020;9(1):100.

Curbelo J, Bueno SL, Galván-Román JM, Ortega-Gómez M, Rajas O, Fernández-Jiménez G, et al. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One. 2017;12(3):0173947.

WHO. Fact sheet: Clinical management of COVID-19 patients: living guidance, 2021. Available at: https://app.magicapp.org/#/guideline/j1WBYn/section/j2xMZn. Accessed on 29 May 2021.

Mousavi-Nasab SD, Mardani R, Nasr Azadani H, Zali F, Vasmehjani A, Sabeti S, et al. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVID-19 patients. Gastroenterol Hepatol Bed Bench. 2020;13(4):361-6.

Garg PK, Khera PS, Saxena S. Chest-X-ray-Based Scoring, Total Leukocyte Count, and Neutrophil-to-Lymphocyte Ratio for Prediction of COVID-19 in Patients with Severe Acute Respiratory Illness. Turk Thorac J. 2021;22(2):130-6.

Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Rev Assoc Médica Bras. 2020;66(6):746-51.

Kong M, Zhang H, Cao X, Mao X, Lu Z. Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19. Epidemiol Infect. 2020;148:139.

Eslamijouybari M, Heydari K, Maleki I, Moosazadeh M, Hedayatizadeh-Omran A, Vahedi L, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19 patients and control group and relationship with disease prognosis. Casp J Intern Med. 2020;11(1):531-5.

Yang AP, Liu J, Tao W, Li H. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.

Chan AS, Rout A. Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19. J Clin Med Res. 2020;12(7):448-53.

Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24(1):647.

Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross‐sectional study. J Med Virol. 2020:10.

Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18:206.