Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19

Seyit, Murat; Avcı, Esin; Nar, Rukiye; Şenol, Hande; Yılmaz, Atakan; Özen, Mert; Oskay, Alten; Aybek, Hülya

doi:10.1016/j.ajem.2020.11.058

Cited by 157 publications

(182 citation statements)

References 15 publications

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“…Severe subjects had a higher NLR compared to Non-Severe patients, similar to the results obtained by others [25][26][27], and above the mean (3.27, 95% CI: 1.99-4.55) reported in a meta-analysis [28].The sensitivity (66%) and speci city (48%) were however fair for this indicator and below the levels reported for these parameters elsewhere [29,30]. Despite this, neutrophilia is the hallmark of severe COVID-19.…”

Section: Discussionsupporting

confidence: 88%

“…The PLR parameter reveals changes in platelet and lymphocyte counts because of acute in ammatory and pro-thrombotic conditions [36]. PLR levels associated with severe COVID-19 were within the range, since they were either higher [1,25,37] or lower [29] than the reference. PLR was higher in men, with a sensitivity of 71% (only 37% in women) and a speci city of 41%, (76% in women), which was suggestive of a different cytokine storm in COVID-19 patients [38] pending on the sex.…”

Section: Discussionmentioning

confidence: 99%

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Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Predicting Covid-19 Severity.

Fors

Ballaz

Ramírez

et al. 2021

Preprint

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Background The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and mean platelet volume-to-platelet ratio (MPR) are combined hematology tests useful for the assessment of COVID-19 severity, but different cut-off values have been reported. Sex can significantly impact immune responses and the course of COVID-19, so these combined hematology tests should be differentiated by gender. Purpose The aim of this study was to evaluate sex differences in the contribution of the NLR, PLR, MLR and MPR to severity and mortality using a sample of COVID-19 patients infected with SARS-CoV-2 from Quito (Ecuador). Methods This single center observational cross-sectional study included 3280 subjects with COVID-19 disease admitted in the IESS Hospital from Quito. Subjects over 18 years old having a positive result in the real time reverse transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2. Confirmed COVID-19 cases were categorized as Severe (PaO2 < 60 mmHg) and Non-Severe (PaO2 ≥ 60 mmHg). Area under the curve, sensibility and specificity were calculated for these ratios to identify optimal cut-offs according to gender to predict severity and mortality in COVID-19 subjects. Results Covid-19 mortality rate among men was double that in women. Severe and non-surviving patients had a higher NLR and MLR, and a lower MPR. A higher PLR was also associated with severity, but not with mortality. The means of NLR, MLR, and PLR in men were significantly higher, yet MPR levels were lower than in women. In men, these ratios had lower cut-offs than in women (NLR: 2.42 vs. 3.31, MLR: 0.24 vs. 0.35 and PLR: 83.9 vs. 151.9). The sensitivity of NLR, MLR and PLR to predict severity was better in men (69%-77%), while their specificity enhanced in women compared to men (70%-76% vs. 23%-48%). Conclusion High NLR, MLR, PLR and low MPR levels were related to COVID-19 severity with different performance in men and women.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Predicting Covid-19 Severity.

Fors

Ballaz

Ramírez

et al. 2021

Preprint

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“…Although the definitive diagnosis of COVID-19 disease is the RT-PCR test, many routine and non-routine biological and biochemical parameters have been examined for their diagnostic values and clinical outcomes [ [2] , [3] , [4] , [5] , [6] , [7] ]. In the Cochrane database, 21 studies that include the laboratory data of 56,585 non-COVID-19 patients and 14,126 COVID-19 patients were reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…Many diagnostic and prognostic biomarkers associated with COVID-19 disease have been revealed and investigated in the literature. These include D-dimer, C-Reactive protein (CRP), neutrophil count, leukocyte count, lymphocyte ratio, neutrophil-to-lymphocyte ratio, ferritin, procalcitonin and others not routinely tested in the diagnosis and clinical prognosis of COVID-19 [ [2] , [3] , [4] , [5] , [6] , [7] ].…”

Section: Introductionmentioning

confidence: 99%

Soluble P-selectin as a potential diagnostic and prognostic biomarker for COVID-19 disease: A case-control study

et al. 2021

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Introduction To our knowledge, the diagnostic value of the sP-Selectin level in the diagnosis of COVID-19 disease has not yet been investigated. In this study, we aimed to assess this by evaluating the relationship between sP-Selectin level and the clinical severity of COVID-19 infections. Methods A total of 80 patients (50 with mild to moderate and 30 with severe COVID-19 pneumonia), and 60 non-symptomatic healthy volunteers participated in the study. Following serum isolation, sP-Selectin levels were assessed by Enzyme-Linked Immunosorbent Assay (ELISA) method. Results The serum sP-Selectin level was 1.7 ng/ml in the control group (1–3.78); 6.24 ng/ml (5.14–7.23) in mild-to-moderate pneumonia group; and 6.72 ng/ml (5.36–8.03) in the severe pneumonia group. Serum sP-Selectin levels in both mild-to-moderate pneumonia and severe pneumonia groups were found to be higher than the control group, with statistical significance ( p = 0.0001 and p = 0.0001, respectively). Receiver operating characteristic analysis (ROC) showed greater area under the curve (AUC) for the serum sP-Selectin levels of the COVID-19 patients (AUC = 0.913, 95% CI = 0.857–0.969; p = 0.0001). The serum sP-Selectin level was found to be 97.5% sensitive and 80% specific at 4.125 ng/ml level for diagnosis (p = 0.0001). The serum sP-Selectin level was found to be 76.9% sensitive and 51.9% specific at the level of 6.12 ng/ml ( p = 0.005) to predict the need for intensive care treatment. Conclusion This study showed that sP-Selectin can be used as a valuable biomarker in both diagnosing and predicting the need for intensive care treatment of COVID-19 infection.

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“…AST [99][100][101], creatinine [102][103][104], fibrinogen [105][106][107], neutrophils [108,109], and respiratory rate [14,110] were reported to be positively related to the severity of COVID-19. Murat et al found that lymphocyte and platelet levels were higher in positive COVID-19 patients, while C-reactive protein (CRP) was higher in COVID-19negative patients [111]. Wang also found that lower lymphocyte counts and elevated CRP were risk factors for severity [112].…”

Section: Discussionmentioning

confidence: 99%

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

et al. 2021

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To analyse the prevalence of severe and critical COVID-19 cases and its determinants, a systematic review and meta-analysis were conducted using Review Manager. Four English and two Chinese databases were used to identify and explore the relationships between the severity of COVID-19 and its determinants, with no restrictions on publication date. The odds ratio and 95% CI were combined to assess the influencing level of all factors. Twenty-three articles containing a total of 15,828 cases of COVID-19 were included in this systematic review. The prevalence of severe and critical COVID-19 cases was 17.84% and 4.9%, respectively. A total of 148 factors were identified, which included behavioural, symptom, comorbidity, laboratory, radiographic, exposure, and other factors. Among them, 35 factors could be included in the meta-analysis. Specifically, for example, the male (OR 1.55, 95% CI 1.42–1.69) and elderly (OR 1.06, 95% CI 1.03–1.10) populations tended to experience severe and critical illness. Patients with cough, dyspnea, fatigue, fever, and gastrointestinal symptoms could have severe and critical diseases. Regarding laboratory results, albumin, aspartate aminotransferase, creatinine, D-dimer, fibrinogen, neutrophils, procalcitonin, platelets, and respiratory rate were potential factors that could be used to predict the severity of COVID.

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Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19

Cited by 157 publications

References 15 publications

Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Predicting Covid-19 Severity.

Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Predicting Covid-19 Severity.

Soluble P-selectin as a potential diagnostic and prognostic biomarker for COVID-19 disease: A case-control study

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

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