Do initial hematologic indices predict the severity of COVID-19 patients?

Abstract

Background/aim: In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods: Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM x PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and compared between the mild/moderate and severe groups. Results: The proportion of COVID-19 cases admitted to ICU was 3.9%. The median age of patients admitted to ICU was significantly higher than those who were not; (68.5 (interquartile range (IQR); 21.5) years vs. 41.0 (IQR; 15.7) years; p <0.001). Severe cases had higher NLR (6.6 vs 2.4; P <0.001), and MLR (0.40 vs 0.28; P=0.004) and lower PLR (180.0 vs 129.0; P <0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729-0.910; p<0.001). Conclusion: These data showed that age, initial NLR, PLR, and LYM x PLT were associated with the severity of COVID-19 disease and patients' need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.

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.

“…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.…”

“…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.…”

Mean Platelet Volume Predicts Severe COVID-19 Illness

“…A total number of 18 studies were finally included in our analysis, with 3,433 COVID-19 patients, 780 (22.7%) with severe illness (►Table 1). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] All except two were crosssectional studies, with the majority from China (7; 39%), and used heterogeneous combination of clinical endpoints for defining severity of COVID-19 (44% included respiratory failure and/or intensive care unit admission, 33% death, and 6% acute kidney failure or thrombosis; ►Table 1).…”

Platelet size as a predictor for severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Consequently, most authors had no control over the exposure assessment and did not fully describe the methods used to measure the platelet parameters. Only four studies provided the number of eligible patients and the total number included in the study [19, 21, 30, 31]. This inhibited the assessment of participation rate in the other studies.…”