Summary Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we highlight in this viewpoint the importance of the neutrophil to lymphocyte ratio in COVID-19 pandemic-infected patients.

Background & Aims Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we hypothesized that ICU patients infected by COVID-19 had lower blood vitamin D levels and increased systemic inflammation. Therefore, this is the first Brazilian study to evaluate the vitamin D concentrations and NLR as a systemic inflammation in patients infected by COVID-19 admitted in ICU. Methods This cross-sectional study selected twenty-six patients from COVID-19 Data Sharing/FAPESP, Brazil. Twenty-five patients were enrolled from a single hospital and those with blood vitamin D and neutrophil and lymphocyte data were included and had all available data analyzed. Patients were divided in two groups: low vitamin D concentration when ≤ 20 ng/mL (low Vit D group, n= 8, 5M/3F, 62.7±8.4 years old), and normal vitamin D when > 20 ng/mL (normal Vit D group, n= 17, 9M/8F, 74±8.2 years old). Serum 25-hydroxy-vitamin D, C reactive protein (CRP), and count of neutrophils and lymphocytes concentrations were collected from COVID-19 Data Sharing/FAPESP. Statistical analyses were performed using the Prism version 5.0 and Student T test was applied to verify any difference between the groups. Results Low vitamin D group had 15.5±3.3 ng/mL of 25OH Vit D concentrations and normal vitamin D group had 35.9±8.8 ng/mL. Although no difference between groups for CRP concentrations (low Vit D: 4.5±3.3 vs. normal Vit D: 4.2±4.0 mg/dL, p=0.45), we found higher neutrophil count and NLR values in the low Vit D group when compared to normal Vit D group (low Vit D: 6049.8±3719.7 vs. normal Vit D: 3741.8±1704.1 ng/mL, p=0.02) and (low Vit D: 9.0±8.6 vs. normal Vit D: 4.2±4.0 ng/mL, p=0.03), respectively. Conclusion This data sharing-derived cases of COVID-19 in patients admitted at ICU showed that patients infected by COVID-19 had lower serum 25-hydroxy vitamin D and enhanced systemic inflammation when assessed by NLR values.