Platelet-derived immuno-inflammatory indices show best performance in early prediction of COVID-19 progression

Abstract

Background: Coronavirus disease 2019 (COVID-19) profoundly affects the immune and hematopoietic systems with various degrees of reactive changes in the blood cell counts. Immuno-inflammatory indices are considered a simple and effective tool in the prediction of COVID-19 outcomes. We aimed to evaluate and compare the usefulness of leukocyte and platelet counts-based immuno-inflammatory indices on admission to hospital in predicting COVID-19 progression and mortality.

Methods: A total of 945 patients were enrolled. In addition to blood cell counts, we assessed hemogram-derived immuno-inflammatory indices in relation to COVID-19 progression and death. The indices were tested by analysis of variance, receiver operating characteristic curve analysis, and binomial logistic regressions.

Results: Patients with severe COVID-19 had significantly higher counts of neutrophils, eosinophils, and large immature cells (LIC), while decreased counts of platelets and monocytes. Lymphopenia was found in all of the patients, but without significant association with the outcomes. Patients with a LIC count ≥0.265 x 0⁹ /L had 54.7% more odds of having COVID-19 progression. In multivariable analyses, platelets/neutrophil-to-lymphocyte ratio (P/NLR) and platelets-to-neutrophil radio (P/N) were significant independent predictors of COVID-19 progression and mortality. The odds of a poor outcome were two times higher in cases with P/NLR < 43 x 10⁹ /L and P/N < 29 x 10⁹ /L.

Conclusion: Indices that include platelet count in combination with neutrophil and/or lymphocyte counts displayed the best discriminatory ability and prognostic value of COVID-19 outcomes. Additionally, LIC showed promising results in the early identification of severe COVID-19.

Keywords: lymphoid and myeloid progenitor cells; lymphopenia; neutrophils; severe acute respiratory syndrome coronavirus 2; thrombocytopenia.

FIGURE 1

Title: The ROC curve analyses of variables in discrimination of patients with high risk of COVID‐19 progression and death. Legend: A. The ROC curve analyses in relation to COVID‐19 progression. B. The ROC curve analyses in relation to COVID‐19 mortality. AUC, area under the curve; LIC, large immature cells; RDW, red cell distribution width; NLR, neutrophil to lymphocyte ratio; SII, systemic immune inflammation index; LY/L, lymphocyte to leukocyte ratio; P/N, platelets to neutrophil ratio; P/NLR, platelets to NLR ratio