Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study

Lin, Hui; Lin, Sheng Feng; Chang, Hui; Lee, Yuarn Jang; Chen, Ray Jade; Hou, Sen

doi:10.1371/journal.pone.0241262

Cited by 42 publications

(59 citation statements)

References 36 publications

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“…This suggestion seems consistent with COVID-19 studies highlighting the predictive role of neutrophils-to-lymphocyte ratio (NLR) and other similar cell ratios, based on combination of myeloid and lymphoid subsets [29][30][31]. Very recently, a diagnostic test using NLR and MDW has been demonstrated to accurately distinguish COVID-19 from in uenza and common upper respiratory tract infections in patients with suspected symptoms (AUC: 0.84; MDW threshold, ≥20) [32].…”

Section: Discussionsupporting

confidence: 84%

Monocyte Distribution Width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients

Riva

Castellano

Nasillo

et al. 2021

Preprint

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Background: Monocyte Distribution Width (MDW), a new cytometric parameter correlating with cytomorphologic changes occurring during massive monocyte activation, has recently been described as promising early biomarker of sepsis. Similar to sepsis, in SARS-CoV-2-associated disease (COVID-19) monocyte/macrophage subsets are considered key mediators of the life-threatening hyper-inflammatory disorder –commonly defined as ‘cytokine storm’– which is part of the complex infection-associated immune dysregulation observed in severe COVID-19 cases (possibly constituting a kind of viral sepsis). Therefore, in this work, we aimed at investigating, for the first time, possible roles of MDW testing in the monitoring of COVID-19 patients.Methods: We longitudinally measured MDW values (readily available along with automated blood cell count) in a cohort of 87 patients with COVID-19 diagnosis, consecutively admitted to our clinics in early 2020, due to aggravation of their clinical status. Statistical analyses were then applied to correlate MDW values with inflammatory markers, disease severity, clinical trajectories and final outcome.Results: We initially found significant direct correlations between MDW and different inflammatory markers routinely assessed during hospitalization, namely CRP (p<0.001), fibrinogen (p<0.001) and ferritin (p<0.01). Moreover, high MDW values resulted remarkably associated with fatal outcome of severe COVID-19 patients (AUC=0.76, 95% CI: 0.66-0.87, sensitivity 0.75, specificity 0.70, MDW threshold 26.4; RR=4.91, 95% CI: 1.73-13.96; OR=7.14, 95% CI: 2.06-24.71). Furthermore, when evaluating MDW dynamics in COVID-19 cases with longer follow-up, we frequently observed progressive MDW increment in patients with worsening inflammation, while clinical recovery was consistently associated with MDW decrease. Of note, MDW evaluation may also help to assess the response to immunomodulatory treatments, such as tocilizumab. Conclusions: Our pilot study shows that MDW can be useful in the monitoring of COVID-19 patients, as this innovative hematologic biomarker is (i) easy and rapid to obtain, (ii) directly related to the activation state of a fundamental inflammatory cell subset (i.e. monocytes, pivotal in both cytokine storm and sepsis immunopathogenesis), (iii) well correlated with clinical severity of COVID-19-associated inflammatory disorder, and, in turn, (iv) endowed with relevant prognostic significance. Additional studies are needed to define further the clinical impact of MDW testing in the management of COVID-19 patients.

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Section: Discussionsupporting

confidence: 84%

Monocyte Distribution Width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients

Riva

Castellano

Nasillo

et al. 2021

Preprint

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“…Only two studies investigated the NLR levels in COVID-19 compared to In uenza. One found no difference, and the other found that NLR was signi cantly lower in the COVID-19 patients (median of 2.6), as was described in our report 32,44 . In all reports, as in ours, CRP levels at admission were similar across the viruses.…”

Section: Discussionsupporting

confidence: 78%

“…Reviewing the literature we found few small -scale studies comparing laboratory parameters of adult patients with COVID- 19 and In uenza 32,42,43 and none compared with RSV. Only two studies investigated the NLR levels in COVID-19 compared to In uenza.…”

Section: Discussionmentioning

confidence: 99%

“…One recently published very small scale study from Taiwan investigated NLR as a marker for likelihood of COVID-19, in order to distinguish the disease from other upper respiratory infections (URI) in the early phase 32 . However, in their analysis, NLR elevation showed no difference between COVID- 19 and URI. In uenza virus and respiratory syncytial virus are the two major viral pathogens associated with acute lower respiratory infection 33 .…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Prozan¹,

Shusterman²,

Ablin³

et al. 2020

Preprint

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Background: A high Neutrophil to Lymphocyte Ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV).Method: A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. Results: 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P<0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.643, compared with 0.497 and 0.537 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 4.7) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 1.6, P=0.005). Conclusions: NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

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“…For adult COVID-19 patients, a small study showed a higher level of neutrophil count in patients admitted to ICU than in those not [14]. NLR is useful in diagnosing in uenza virus infections and in discriminating other respiratory infections [22,23]. In COVID-19 patients, elevated NLR is an independent factor for poor clinical outcome [24,25].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical features on admission between coronavirus disease 2019 and influenza A among children: a retrospective study in China

Liang

Wang

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) share similar symptoms with influenza A (IA), but it is more worthwhile to understand the disparities of the two infections regarding their clinical characteristics on admission. Methods: A total of 71 age-matched pediatric IA and COVID-19 patient pairs were formed and their clinical data on admission were compared. Results: Fever, cough, nasal congestion and nausea/vomiting were the most common symptoms on admission for both infections but occurred less often in COVID-19. The IA patients were more likely to have lower-than-normal levels of lymphocyte count and percentage and to have higher-than-normal levels of activated partial thromboplastin time, prothrombin time, serum C-reactive protein, and serum procalcitonin, while the COVID-19 patients had higher odds of having lower-than-normal levels of neutrophil count and percentage. Conclusion: This study suggests that influenza A is more symptomatic than COVID-19 for children and might be an overall more severe infection at the time of admission.

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Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study

Cited by 42 publications

References 36 publications

Monocyte Distribution Width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients

Monocyte Distribution Width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients

Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Comparison of clinical features on admission between coronavirus disease 2019 and influenza A among children: a retrospective study in China

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