Can Hematological Ratios Predict Outcome of COVID-19 Patients? A Multicentric Study

Abstract

Introduction Coronaviruses belong to a large family that leads to respiratory infection of various severity. Hematological ratios are indicators of inflammatory response widely used in viral pneumonia with affordability in developing countries. Purpose Study the role of the neutrophil lymphocyte ratio (NLR), derived NLR ratio (d-NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) in predicting the outcome of COVID-19 Egyptian patients. Methods A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers, grouped into non-severe, severe, and critical. Patients’ laboratory assessment including total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, d-NLR, LMR and, PLR were reported as well as C reactive protein (CRP), D-dimer and serum ferritin. Results TLC, ANC, AMC, NLR, d-NLR and, PLR were highest in the critical group ( p <0.001 for all except AMC p =0.033), while this group had the least ALC and LMR ( p =0.049 and <0.001, respectively). Higher CRP and d-dimer levels were reported in the critical group ( p <0.001). At the same time, higher ferritin was found in the severe group more than the critical and non-severe groups ( p <0.001, p =0.005, respectively). We calculated the optimal cut-off values of the hematological ratio; NLR (3.5), d-NLR (2.86), PLR (192), and LMR (3). D-NLR had the highest specificity (89.19%), while NLR had the highest sensitivity (71.38%). By univariate logistic regression, age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PLR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with the severity of COVID-19. Still, only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. Conclusion NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PLR may assist in risk stratification.

Mortality and Clinical Outcomes among Patients with COVID-19 and Diabetes

“…In our study, patients with DM had more severe involvement in CXR and higher TLC and ANC/ALC ratios. ANC/ALC ratio correlated with severe disease and mortality in previous studies [ 48 , 49 ]. The optimal cut-off value for ANC/ALC ratio in the study by Aly et al [ 49 ] was 3.5.…”

“…ANC/ALC ratio correlated with severe disease and mortality in previous studies [ 48 , 49 ]. The optimal cut-off value for ANC/ALC ratio in the study by Aly et al [ 49 ] was 3.5. In our study, patients with DM had a median ANC/ALC ratio of 3.5, whereas in patients without DM, the value was 2.47.…”

Combined Blood Indexes of Systemic Inflammation as a Mirror to Admission to Intensive Care Unit in COVID-19 Patients: A Multicentric Study

“…These parameters are recommended as biomarkers to assist in diagnosing inflammation, progression, and risk stratification. The NLR, derived NLR (d-NLR), PLR, and monocyte to lymphocyte ratio (MLR) have recently been proved to play a crucial role in diagnosis and severity evaluation of COVID-19 cases [ 18 , 19 , 29 ]; Interestingly, it has been documented that NLR value is a sensitive inflammation marker than absolute neutrophil and lymphocyte levels [ 28 ]. However, up to our knowledge, none of the previous research works have assessed the predictive value of SII, NLPR, SIRI, and AISI to assess the need of COVID-19 patients for ICU admission.…”

Significance of hemogram‐derived ratios for predicting in‐hospital mortality in COVID‐19: A multicenter study

“…There is a wide variation in the cut‐off value of these parameters in published studies. 61 , 62 , 63 The underlying reason may be due to differences in demographic characteristics of the study population 44 , 64 , 65 and differences in the technique applied to select the cut‐off value. We used Youden Index to determine the optimal cut‐off values.…”