Neutrophil to lymphocyte ratio patterns and the severity of COVID-19: A cross sectional study

NLR and severity of COVID-19

Authors

DOI:

https://doi.org/10.22122/cdj.v11i2.729

Keywords:

COVID-19, SARS-CoV-2, Prognosis, Neutrophil-to-Lymphocyte Ratio, Hematological Parameters

Abstract

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR), obtained from a peripheral blood sample, is considered an indicator of subclinical inflammation. The aim of this study was to determine the NLR pattern in the deceased and survivor patients with coronavirus disease 2019 (COVID-19) during hospitalization.

METHODS: This was a cross-sectional analytical study that was performed in Tohid Hospital in Sanandaj, Iran, from March to July 2021. In our study, 30 patients had received the treatments for COVID-19 and did not need to be admitted to the intensive care unit (ICU). They were discharged from the hospital and considered "Group A". Besides, 21 patients who were admitted to the ICU but were discharged were considered "Group B". Finally, 40 patients with COVID-19 who were hospitalized in the ICU and died were considered "Group C". Complete blood count (CBC) test was performed for all patients at 3 different times (at the time of admission, mid-hospitalization, and the last day of hospitalization). In the end, the data were analyzed by one-way analysis of variance (ANOVA) and the Kruskal-Wallis H test.

RESULTS: 91 patients were included in this study. The NLR index during hospitalization in Group C was significantly higher than in Group B and in Group B was significantly higher than in Group A. On the other hand, in Group C, the NLR was significantly increased at three consecutive times during hospitalization; however, in Group B and Group A, at the end of hospitalization, this ratio was lower than in mid-hospitalization.

CONCLUSION: The NLR was an important indicator in predicting patients' prognoses. Pulmonary inflammation in patients with COVID-19 will be accompanied dominantly by neutrophils; thus, the NLR parameter could be important in the progress of the clinical status.

References

Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res. 2011; 81: 85-164.

Hui DS, Azhar I, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020; 91: 264-6.

Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in COVID-19 patients: A systematic review and meta-analysis. J Prev Med Hyg. 2020; 61(3): E304-E312.

Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. BMJ. 2020; 369: m1966.

Rose J, Suter F, Furrer E, Sendoel A, Stussi-Helbling M, Huber LC. Neutrophile-to-Lymphocyte Ratio (NLR) Identifies Patients with Coronavirus Infectious Disease 2019 (COVID-19) at High Risk for Deterioration and Mortality-A Retrospective, Monocentric Cohort Study. Diagnostics (Basel). 2022; 12(5): 1109.

Valizadeh Ardalan P, Servatyari K, Kashefi H, Afrasiabian S, Abdi M, Ahmadi A. The relationship between inflammatory markers extracted from complete blood count and active pulmonary tuberculosis. Reviews and Research in Medical Microbiology. 2019; 30(1): 18-25.

Manjili RH, Zarei M, Habibi M, Manjili MH. COVID-19 as an acute inflammatory disease. J Immunol. 2020; 205(1): 12-9.

Regolo M, Vaccaro M, Sorce A, Stancanelli B, Colaci M, Natoli G, et al. Neutrophil-to-lymphocyte ratio (NLR) is a promising predictor of mortality and admission to intensive care unit of COVID-19 patients. J Clin Med. 2022; 11(8): 2235.

Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007; 38(12): 1336-45.

Wang Y, Ju M, Chen C, Yang D, Hou D, Tang X, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018; 10(1): 273-82.

Caldwell RW, Rodriguez PC, Toque HA, Narayanan SP, Caldwell RB. Arginase: A multifaceted enzyme important in health and disease. Physiol Rev. 2018; 98(2): 641-65.

Xu W, Zheng S, Dweik RA, Erzurum SC. Role of epithelial nitric oxide in airway viral infection. Free Radic Biol Med. 2006; 41(1): 19-28.

Pirsalehi A, Salari S, Baghestani A, Vahidi M, Khave LJ, Akbari ME, et al. Neutrophil-to-lymphocyte ratio (NLR) greater than 6.5 may reflect the progression of COVID-19 towards an unfavorable clinical outcome. Iran J Microbiol. 2020; 12(5): 466-74.

Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-lymphocyte ratio and outcomes in louisiana COVID-19 patients. Shock. 2020; 54(5): 652-8.

Chan AS, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020; 12(7): 448-53.

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020; 81(1): e6-e12.

Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020; 92(10): 1733-4.

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Published

2023-05-20

How to Cite

1.
Servatyari K, Makrooni R, Rahmani K, Yazdanpanah H, Afrasiabian S. Neutrophil to lymphocyte ratio patterns and the severity of COVID-19: A cross sectional study: NLR and severity of COVID-19. Chron Dis J. 2023;11(2):118–123.

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Short Communication(s)