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. 2021 Nov-Dec;35(6):3305-3313.
doi: 10.21873/invivo.12626.

Combination of the CD8+:B-cell and Neutrophil-to-Lymphocyte Ratio as a Novel Prediction Model for Intubation Need and Disease Severity in COVID-19 Patients

Maria G Detsika  1 , Eirini Grigoriou  2 , Katherina Psarra  2 , Edison Jahaj  1 , Stamatios Tsipilis  1 , Nikolaos Athanassiou  1 , Alexandros Zacharis  1 , Ioanna Dimopoulou  1 , Stylianos E Orfanos  1 , Alexandra Tsirogianni  2 , Anastasia Kotanidou  3
Affiliations

Combination of the CD8+:B-cell and Neutrophil-to-Lymphocyte Ratio as a Novel Prediction Model for Intubation Need and Disease Severity in COVID-19 Patients

Maria G Detsika et al. In Vivo. 2021 Nov-Dec.

Abstract

Background: The study provides a novel prediction model for COVID-19 progression and outcome by the combination of the CD8+: B-cells ratio with neutrophil-to-lymphocyte ratio (NLR).

Patients and methods: Immune phenotyping was performed in 120 COVID-19 patients.

Results: A decrease in CD8+:B-cell (p<0.0001) and in lymphocyte-to-CRP (LCR) ratio (p<0.0001) was observed in intubated patients versus non-intubated with an increase for CD4+:CD8+ (p<0.01), NLR (p<0.0001) and CRP: Albumin (p<0.001). Receiving operating curve (ROC) analysis predicting requirement for mechanical ventilation revealed the highest AUC for CD8+:B-cells, (AUC=0.795, p<0.001) versus NLR (AUC=0.783, p<0.001), LCR (AUC=0.779, p<0.001), Albumin:CRP (AUC=0.750, p<0.001) and CD4+:CD8+ (AUC=0.779, p<0.001). Combination of the CD8+: B-cell ratio with the NLR increased the AUC (AUC=0.845, p<0.001). The combined ratios correlated with outcome defined as duration of hospital (r=0.435, p<0.001) or ICU stay (r=0.596, p<0.001).

Conclusion: Combination of the CD8+: B-cell ratio and NLR serves as a useful prognostic tool for COVID-19 patient progression.

Keywords: COVID-19; SARS-COV-2; disease progression; immune phenotyping; intensive care unit; mechanical ventilation; prognostic markers.

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Conflict of interest statement

The Authors declare no competing interests.

Figures

Figure 1
Figure 1. Representative gating strategy for immune profiling of coronavirus disease 2019 (COVID-19) patients.
Figure 2
Figure 2. Severe decrease of the CD8+: B-cell ratio in intubated patients. A significant decrease of the CD8+: B-cell ratio was observed between non-intubated and intubated (A) as well as an increase for CD4+:CD8+ (B), neutrophil-to-lymphocyte ratio (NLR), a decrease in lymphocyte-toCRP ratio (C) and an increase in CRP:Albumin ratio (E). Statistical analysis was performed by Mann-Whitney U-test. ****p<0.0001, ***p<0.001.
Figure 3
Figure 3. Severe decrease of the CD8+: B-cell ratio in non-survivors versus survivors. A significant decrease of the CD8+: B-cell ratio was observed between non-intubated and intubated patients (A) as well as an increase for CD4+:CD8+ (B), neutrophil-to-lymphocyte ratio (NLR), a decrease in lymphocyte-to-CRP ratio (C) and an increase in CRP:Albumin (E). Statistical analysis was performed by Mann-Whitney U-test. *p<0.05, **p<0.01, ****p<0.0001.
Figure 4
Figure 4. Prognostic value of the CD8+: B cell ratio. Receiving operating curve analysis for predicting the requirement of mechanical ventilation in COVID-19 patients by (A) CD8+:B cell, CD4+:CD8+, neutrophil-toly mphocyte ratio (NLR), lymphocyte-to-CRP ratio (LCR) and CRP:Albumin ratio and (B) by the combination of CD8+: B cells with NLR.
Figure 5
Figure 5. Combined CD8+: B cell and NLR ratios as a prognostic tool for COVID-19 outcome. Correlation analysis revealed a negative correlation of CD8+:B cells with (A) outcome defined as duration of hospitalization (days) and (B) outcome defined as duration of ICU stay. Positive correlation with outcome for NLR (C, D) and combined CD8+: B cell ratio with NLR (E, F).
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