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. 2020 Aug:85:106683.
doi: 10.1016/j.intimp.2020.106683. Epub 2020 Jun 6.

Neutrophil to CD4+ lymphocyte ratio as a potential biomarker in predicting virus negative conversion time in COVID-19

Haizhou Wang  1 , Yongxi Zhang  2 , Pingzheng Mo  2 , Jing Liu  1 , Hongling Wang  1 , Fan Wang  3 , Qiu Zhao  4
Affiliations

Neutrophil to CD4+ lymphocyte ratio as a potential biomarker in predicting virus negative conversion time in COVID-19

Haizhou Wang et al. Int Immunopharmacol. 2020 Aug.

Abstract

Background: Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. Our study aimed to evaluate the robustness of neutrophil to CD4+ lymphocyte ratio (NCD4LR) in predicting the negative conversion time (NCT) of SARS-CoV-2 in COVID-19 patients.

Methods: Univariate and multivariate analysis were conducted to evaluate the independency of NCD4LR in predicting NCT. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to assess the diagnostic accuracy.

Results: Compared with low NCD4LR patients, patients with high NCD4LR had an older age; higher incidence of fever, fatigue, chest distress/breath shortness, severer disease assessment on admission; higher levels of inflammatory indicators; low levels of lymphocyte subsets, and a longer NCT. Multivariate analysis also identified NCD4LR as an independent risk factor for delayed NCT. ROC analysis showed that NCD4LR had a better performance than neutrophil to lymphocyte ratio in predicting the virus negative conversion within 2 weeks (AUC = 0.772), 3 weeks (AUC = 0.710), 4 weeks (AUC = 0.728), or 5 weeks (AUC = 0.815).

Conclusion: This study suggests that NCD4LR is a potential and useful biomarker for predicting the virus negative conversion time in COVID-19 patients. Furthermore, due to the NCDLR value is easily calculated, it can be widely used as a clinical biomarker for disease progression and clinical outcomes in COVID-19 patients.

Keywords: COVID-19; Negative conversion time; Neutrophil to CD4+ lymphocyte ratio; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
ROC curve analysis of NCD4LR and NLR in predicting the negative conversion of SARS-CoV-2 within 2 (a), 3 (b), 4 (c), or 5 (d) weeks from symptom onset. ROC, receiver operating characteristic; AUC, area under ROC curve; NCD4LR, neutrophil to CD4+ lymphocyte ratio; NLR, neutrophil to lymphocyte ratio.
Fig. 2
Fig. 2
Stratified analysis based on the severity of the patients’ condition. (a) ROC curve analysis of NCD4LR and NLR in predicting the negative conversion within 2 weeks for general patients. (b) ROC curve analysis of NCD4LR and NLR in predicting the negative conversion within 5 weeks for critical patients. (c) For severe patients, ROC curve analysis of NCD4LR and NLR in predicting the negative conversion within 3, 4, or 5 weeks. ROC, receiver operating characteristic; AUC, area under ROC curve; NCD4LR, neutrophil to CD4+ lymphocyte ratio; NLR, neutrophil to lymphocyte ratio; NCT, negative conversion time.
Supplementary figure 1
Supplementary figure 1
See this image and copyright information in PMC

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