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Multicenter Study
. 2020 Nov;54(5):652-658.
doi: 10.1097/SHK.0000000000001585.

Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients

Danielle Tatum  1 , Sharven Taghavi  2 , August Houghton  2 , Jacob Stover  3 , Eman Toraih  2 , Juan Duchesne  2
Affiliations
Multicenter Study

Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients

Danielle Tatum et al. Shock. 2020 Nov.

Abstract

Background: Due to the rapidly escalating number of cases and the low baseline of overall health in Louisiana, we sought to determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in hospitalized COVID patients in two major metropolitan areas with the highest prevalence of cases and exceedingly high rates of obesity and other comorbid conditions. We hypothesized that elevated NLR would be a prognostic indicator of mortality.

Methods: This was a review of a prospective registry of adult (18+ years) hospitalized Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) patients from two large urban safety net hospitals in Louisiana. Blood cell counts at days 2 and 5 were used to obtain NLR. Receiver operating characteristic curve analysis assessed predictive capacity of NLR on mortality. Kaplan-Meier survival analysis and Cox regression models examined the effect of NLR on survival.

Results: The study population of 125 patients was majority African American (88.6%) and female (54.8%) with a mean age and body mass index of 58.7 years and 34.2. Most (96.0%) had comorbidities of which hypertension (72.0%), obesity (66.7%), and diabetes (40.0%) were the most common. Mortality was 18.4%. NLR > 4.94 on day 1 predicted intubation (P = 0.02). NLR above established cutoff values on hospital days 2 and 5 each significantly predicted mortality (P < 0.001 and P = 0.002, respectively).

Conclusions: NLR is a prognostic factor for endotracheal intubation upon hospital admission and independent predictor for risk of mortality in SARS-CoV-2 patients on subsequent hospital days. Clinical research efforts should examine effects of strategies such as arginase inhibition alone and/or inhaled nitric oxide to ameliorate the effects of elevated NLR.

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Conflict of interest statement

Conflicts of Interest and source of funding: none to declare

Figures

Fig. 1
Fig. 1
Flow diagram for study inclusion.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of NLR on hospital day 1 predicting intubation.
Fig. 3
Fig. 3
Kaplan-Meier survival curves of hospitalized COVID-19 patients above and below established neutrophil to lymphocyte ratio (NLR) cutoff values on (A) hospital day 2 and (B) hospital day 5.
See this image and copyright information in PMC

Comment in

References

    1. The Government of the Hong Kong Special Administration Region Press Release. CHP closely monitors cluster of pneumonia cases on Mainland. 2019; https://www.info.gov.hk/gia/general/201912/31/P2019123100667.htm. Accessed March 23, 2020.
    1. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, Spitters C, Ericson K, Wilkerson S, Tural A, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 382 (10):929–936, 2020. - PMC - PubMed
    1. The World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report -51. 2020; https://www.who.int/docs/default-source/coronaviruse/situation-reports/2.... Accessed April 30, 2020.
    1. Johns Hopkins University & Medicine Coronavirus Resource Center. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE). Coronavirus COVID-19 Global Cases 2020. Available from https://coronavirus.jhu.edu/map.html. (Accessed April 13, 2020)
    1. Governor's Office of Homeland Security and Preparedness Site COVID-19 Louisiana Response: Louisiana Case Info. Available at https://gov.louisianagov/assets/docs/covid/govCV19Brief-2.pdf. (Accessed April 12, 2020)

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