Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

Abstract

COVID-19, caused by SARS-CoV-2, has wreaked havoc on global economies and healthcare systems around the world. The World Health Organization declared COVID-19 a pandemic in March 2020. [1] Waves of new infection and new, more transmissible SARS-CoV-2 variants have led to protracted lockdown regulations in many countries. [2][3][4] While lockdown has been an effective method of 'flattening the curve' , it is not a socially or economically sustainable solution for the long term. The ability of healthcare systems to predict and plan for surges in infection has become crucial.The South African (SA) healthcare system is plagued by a geographical maldistribution of resources. There are 125 390 general hospital beds currently available for SA's population of 60 million. [5] Considering the country's overall high burden of disease, identification of potential risk factors or markers that predict length of hospital stay (LoS) in COVID-19 patients may be of great benefit to health authorities and may assist in triage and contingency planning.Abnormal laboratory parameters identified at admission have been reported to predict in-hospital severity of disease and mortality. [6] Lymphopenia, anaemia, thrombocytopenia, neutrophilia and eleva-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Association between the Neutrophil-to-Lymphocyte Ratio and Inpatient Mortality in Hospitalized Older Veterans with COVID-19 Infection

“…Our findings are consistent with previous studies demonstrating an association between higher NLR scores and an increase in in-hospital mortality 11,13 and critical illness requiring ICU admission or transfer 15 . Our study was consistent with some but not all that higher NLR scores were not associated with LOS 16–19 . The studies supporting NLR association with longer hospital LOS were shown with NLR scores greater than even the high tertile group of our study 16,17 .…”

“…Our study was consistent with some but not all that higher NLR scores were not associated with LOS 16–19 . The studies supporting NLR association with longer hospital LOS were shown with NLR scores greater than even the high tertile group of our study 16,17 . Our study was consistent with a prior study that showed admission NLR did not predict 30-day postdischarge mortality 20 .…”

“…[16][17][18][19] The studies supporting NLR association with longer hospital LOS were shown with NLR scores greater than even the high tertile group of our study. 16,17 Our study was consistent with a prior study that showed admission NLR did not predict 30-day postdischarge mortality. 20 In terms of 30-day readmissions and 6-month and 1-year mortality, there were no studies of hospitalized COVID-19 patients to compare with ours.…”

“…11 Studies revealed the association of high NLR ratios with serious disease, 11,12 progression to critical illness in patients older than age 60 admitted, 15 in-hospital mortality, 11,13 and an increased risk for 1-month mortality. 14 The data on prolonged length of stay (LOS) were mixed, with two studies finding an association 16,17 whereas others did not. 18,19 Only one study looked at the association of NLR and 30-day postdischarge mortality and found that follow-up, but not initial NLR, was associated with 30-day mortality.…”

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19

“…The relationship between these indices (for example, NLR) and disease severity is not as unequivocal as that of IL-6 and CRP. Increased NLR levels has been observed in patients with Covid-19 in Johannesburg, South Africa but this parameter was not significantly related to prolonged LOS ( 35 ). The NLR has been shown to be useful in identifying young patients with severe Covid-19 (≤40 years) ( 36 ).…”