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. 2020 Jul;81(1):e6-e12.
doi: 10.1016/j.jinf.2020.04.002. Epub 2020 Apr 10.

Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

Yuwei Liu  1 , Xuebei Du  1 , Jing Chen  1 , Yalei Jin  1 , Li Peng  1 , Harry H X Wang  2 , Mingqi Luo  3 , Ling Chen  4 , Yan Zhao  5
Affiliations

Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

Yuwei Liu et al. J Infect. 2020 Jul.

Abstract

Background: Several studies have described the clinical characteristics of patients with novel coronavirus (SARS-CoV-2) infected pneumonia (COVID-19), indicating severe patients tended to have higher neutrophil to lymphocyte ratio (NLR). Whether baseline NLR could be an independent predictor of in-hospital death in Chinese COVID-19 patients remains to be investigated.

Methods: A cohort of patients with COVID-19 admitted to the Zhongnan Hospital of Wuhan University from January 1 to February 29 was retrospectively analyzed. The baseline data of laboratory examinations, including NLR, were collected. Univariate and multivariate logistic regression models were developed to assess the independent relationship between the baseline NLR and in-hospital all-cause death. A sensitivity analysis was performed by converting NLR from a continuous variable to a categorical variable according to tertile. Interaction and stratified analyses were conducted as well.

Results: 245 COVID-19 patients were included in the final analyses, and the in-hospital mortality was 13.47%. Multivariate analysis demonstrated that there was 8% higher risk of in-hospital mortality for each unit increase in NLR (Odds ratio [OR] = 1.08; 95% confidence interval [95% CI], 1.01 to 1.14; P = 0.0147). Compared with patients in the lowest tertile, the NLR of patients in the highest tertile had a 15.04-fold higher risk of death (OR = 16.04; 95% CI, 1.14 to 224.95; P = 0.0395) after adjustment for potential confounders. Notably, the fully adjusted OR for mortality was 1.10 in males for each unit increase of NLR (OR = 1.10; 95% CI, 1.02 to 1.19; P = 0.016).

Conclusions: NLR is an independent risk factor of the in-hospital mortality for COVID-19 patients especially for male. Assessment of NLR may help identify high risk individuals with COVID-19.

Keywords: COVID-19; Mortality; Neutrophil-to-Lymphocyte Ratio; Risk factors.

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Conflict of interest statement

Declaration of Competing Interest The authors state that they have no conflicts of interest to disclosure.

Figures

Fig 1
Fig. 1
Study Population.
Fig 2
Fig. 2
Risk associations between NLR as a continuous variable and in-hospital death in subgroups of gender, age, body mass index and history of hypertension. Data were adjusted for age, sex, body mass index, history of Hypertension, history of chronic liver disease, history of HIV infection, history of chronic obstructive pulmonary disease, smoking status, respiratory rate, alanine transaminase, creatinine, prothrombin time, D-dimer.
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References

    1. Faria S.S., Fernandes P.J., Silva M.J. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702. - PMC - PubMed
    1. Azab B., Zaher M., Weiserbs K.F. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106(4):470–476. - PubMed
    1. Guthrie G.J., Charles K.A., Roxburgh C.S., Horgan P.G., McMillan D.C., Clarke S.J. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–230. - PubMed
    1. Giede-Jeppe A., Bobinger T., Gerner S.T. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis. 2017;44(1-2):26–34. - PubMed
    1. Ha Y.J., Hur J., Go D.J. Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study. Plos One. 2018;13(1) - PMC - PubMed

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