Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19

Kong, Man; Zhang, Hongmei; Cao, Xiaocui; Mao, Xiaoli; Lu, Zhongxin

doi:10.1017/s0950268820001557

Cited by 153 publications

(157 citation statements)

References 20 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…Besides protein S levels, an elevated number of neutrophils also associated with the negative outcome; this is in concordance with the results reported in previous studies, which proved that neutrophils are associated with the severity of the disease and the admission to ICU [23,24].…”

Section: Variables and Statistical Analysissupporting

confidence: 92%

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Stoichitoiu

Pinte

Balea

et al. 2020

Romanian Journal of Internal Medicine

View full text Add to dashboard Cite

Introduction: COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.Aim: Assessment of protein S activity in patients with COVID-19 as a cause this prothrombotic state, and of the association of protein S activity with worse outcome.Methods: All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, secondary outcomes were clinical severity and lung damage.Results: 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p<0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = -0.320, p < 0.001; Jonckheere-Terpstra for trend: p<0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = -0.290, p<0.001; Jonckheere-Terpstra for trend: p<0.001). High neutrophil count was also independently associated with death (p=0.002).Conclusion: Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.

show abstract

Section: Variables and Statistical Analysissupporting

confidence: 92%

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Stoichitoiu

Pinte

Balea

et al. 2020

Romanian Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…In fact, despite a lung-centric immunopathology, currently available data suggest that the clinical spectrum of COVID-19 is not limited to lung involvement, but rather represents a multisystem illness (4). Patients with higher ferritin levels displayed a higher N:L ratio, which has been associated with more severe pulmonary involvement in COVID-19 (45,46). In addition, higher D-dimer levels, hinting coagulation abnormalities, were also detected in COVID-19 patients with higher ferritin levels.…”

Section: Discussionmentioning

confidence: 91%

Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: data from two Italian COVID-19 Units.

Carubbi

Salvati

Alunno

et al. 2020

Preprint

View full text Add to dashboard Cite

The coronavirus 2019 disease (COVID-19) is characterised by a heterogeneous clinical presentation, a complex pathophysiology and a wide range of imaging ﬁndings, depending on disease severity and time course. We conducted a retrospective evaluation of hospitalized patients with proven SARS-CoV-2 infection, clinical signs of COVID-19 and computed tomography (CT) scan-proven pulmonary involvement, in order to identify relationships between clinical, serological, imaging data and disease outcomes in patients with COVID-19. Clinical and serological records of patients admitted to two COVID-19 Units of the Abruzzo region in Italy with proven SARS-CoV-2 pulmonary involvement investigated with CT scan, assessed at the time of admission to the hospital, were retrospectively evaluated.Sixty-one patients (22 females and 39 males) of median age 65 years were enrolled. Fifty-six patients were discharged while death occurred in 5 patients. None of the lung abnormalities detected by CT was different between discharged and deceased patients. No differences were observed in the features and extent of pulmonary involvement according to age and gender. Logistic regression analysis with age and gender as covariates demonstrated that ferritin levels over the 25th percentile were associated with the involvement of all 5 pulmonary lobes (OR=14.5, 95% CI=2.3-90.9, p=0.004), the presence of septal thickening (OR=8.2, 95% CI=1.6-40.9, p=0.011) and the presence of mediastinal lymph node enlargement (OR=12.0, 95% CI=1.1-127.5, p=0.039) independently of age and gender.We demonstrated that ferritin levels over the 25th percentile are associated with a more severe pulmonary involvement, independently of age and gender and not associated with disease outcomes. The identification of reliable biomarkers in patients with COVID-19 may help guiding clinical decision, tailoring therapeutic approaches and ultimately improving the care and prognosis of patients with this disease.

show abstract

“…Neutrophil to Lymphocyte ratio (NLR) has been explored as a prognostic marker for COVID-19, with high level of NLR associated with severity of the disease 43,44 or with higher mortality rates 45,46 . More specific subsets of the Lymphocytes, especially the CD4 + and CD8 + T-cell counts are found to be depleted in severe COVID-19 patients 17,47 .…”

Section: Relationship With Immune Cellsmentioning

confidence: 99%

IL-6 and IL-10 as predictors of disease severity in COVID-19 patients: results from meta-analysis and regression

Dhar¹,

Vishnupriyan²,

Damodar³

et al. 2020

Preprint

View full text Add to dashboard Cite

Objectives: SARS-CoV-2, an infectious agent behind the ongoing COVID-19 pandemic, induces high levels of cytokines in patients contributing to the disease patho-physiology. Nonetheless, exact association and contribution of particular cytokines towards COVID-19 pathology remains poorly understood. This study performed a comprehensive meta-analysis to establish association between induced cytokines and COVID-19 disease severity to help in prognosis and clinical management. Methods: Scientific literature was searched to identify 18 clinical studies. Standardized mean difference (SMD) for cytokines IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ between severe and non-severe COVID-19 patient groups were summarized using random effects model. A classifier was built using logistic regression model with cytokines having significant SMD as covariates. Results: Out of the 6 cytokines, IL-6 and IL-10 showed statistically significant SMD across the studies synthesized. Classifier with mean values of both IL-6 and IL-10 as covariates performed well with accuracy of ~ 92% that was significantly higher than accuracy reported in literature with IL-6 and IL-10 as individual covariates. Conclusions: Simple panel proposed by us with only two cytokine markers can be used as predictors for fast diagnosis of patients with higher risk of COVID-19 disease deterioration and thus can be managed well for a favourable prognosis.

show abstract

Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19

Cited by 153 publications

References 20 publications

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: data from two Italian COVID-19 Units.

IL-6 and IL-10 as predictors of disease severity in COVID-19 patients: results from meta-analysis and regression

Contact Info

Product

Resources

About