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. 2022 Mar 31;14(3):e23696.
doi: 10.7759/cureus.23696. eCollection 2022 Mar.

Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India

Bharatsing D Rathod  1 , Dnyanesh Amle  2 , Rajashree S Khot  1 , Kiran Kumar Prathipati  3 , Prashant P Joshi  1
Affiliations

Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India

Bharatsing D Rathod et al. Cureus. .

Abstract

Background: Clinical presentation of coronavirus disease 2019 (COVID-19) varies from an asymptomatic state to severe disease characterized by acute respiratory distress syndrome, respiratory failure, thrombosis, and multi-organ dysfunction syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been reviewed as one of the laboratory factors that have been proposed to predict the severity of disease and mortality in COVID-19 pandemic.

Aim and objectives: To evaluate the association between NLR and the disease severity and mortality in COVID-19.

Materials and methods: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in a tertiary-care teaching medical institute of Central India. COVID-19 patients of the age group 18 years and above admitted during the study period were included. Cases were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. NLR was calculated by doing a complete blood count at the time of hospitalization by the Mindray BC-6000 auto hematology analyzer. The outcome of the disease was classified as recovery and death during hospitalization. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of NLR at admission to predict severe COVID-19 or mortality. Ordinal regression analysis was used to assess the impact of NLR on disease severity and mortality.

Results: Mean NLR was significantly higher in the severe COVID-19 group as compared to the mild/moderate group and in deceased as compared to discharged cases. ROC curve analysis revealed NLR to be an excellent predictor of disease severity as well as a prognostic parameter for risk of death. NLR was found to be a significant independent positive predictor for contracting the severe disease (Odd's ratio 1.396, 95% CI=1.112-1.753, p=0.004) and mortality (Odd's ratio 1.276, 95% CI=1.085-1.499, p=0.003).

Conclusion: High NLR was significantly associated with the disease severity and mortality in COVID-19.

Keywords: covid-19; cytokine storm; mortality; neutrophil-to-lymphocyte ratio (nlr); severity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Recruitment and assessment flowchart for the participants
NLR: neutrophil-to-lymphocyte ratio; COVID-19: coronavirus disease 2019
Figure 2
Figure 2. ROC curve analysis to predict NLR as predictor of disease severity (A) and death (B)
ROC: receiver-operating characteristic; NLR: neutrophil-lymphocyte ratio
See this image and copyright information in PMC

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References

    1. World Health Organisation. WHO Coronavirus (COVID-19) Dashboard. [ May; 2022 ];https://covid19.who.int 2022
    1. Factors associated with COVID-19-related death using OpenSAFELY. Williamson EJ, Walker AJ, Bhaskaran K, et al. Nature. 2020;584:430–436. - PMC - PubMed
    1. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Huang C, Wang Y, Li X, et al. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Ruan Q, Yang K, Wang W, Jiang L, Song J. Intensive Care Med. 2020;46:846–848. - PMC - PubMed
    1. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. Crit Rev Oncol Hematol. 2013;88:218–230. - PubMed

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