Lymphocyte–C-reactive protein ratio can differentiate disease severity of COVID-19 patients and serve as an assistant screening tool for hospital and ICU admission

Abstract

In this study, we aimed to explore whether lymphocyte–C-reactive protein ratio (LCR) can differentiate disease severity of coronavirus disease 2019 (COVID-19) patients and its value as an assistant screening tool for admission to hospital and intensive care unit (ICU). A total of 184 adult COVID-19 patients from the COVID-19 Treatment Center in Heilongjiang Province at the First Affiliated Hospital of Harbin Medical University between January 2020 and March 2021 were included in this study. Patients were divided into asymptomatic infection group, mild group, moderate group, severe group, and critical group according to the Diagnosis and Treatment of New Coronavirus Pneumonia (ninth edition). Demographic and clinical data including gender, age, comorbidities, severity of COVID-19, white blood cell count (WBC), neutrophil proportion (NEUT%), lymphocyte count (LYMPH), lymphocyte percentage (LYM%), red blood cell distribution width (RDW), platelet (PLT), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), albumin (ALB), total bilirubin (TB), direct bilirubin (DBIL), indirect bilirubin (IBIL), and D-dimer were obtained and collated from medical records at admission, from which sequential organ failure assessment (SOFA) score and LCR were calculated, and all the above indicators were compared among the groups. Multiple clinical parameters, including LYMPH, CRP, and LCR, showed significant differences among the groups. The related factors to classify COVID-19 patients into moderate, severe, and critical groups included age, number of comorbidities, WBC, LCR, and AST. Among these factors, the number of comorbidities showed the greatest effect, and only WBC and LCR were protective factors. The area under the receiver operating characteristic (ROC) curve of LCR to classify COVID-19 patients into moderate, severe, and critical groups was 0.176. The cutoff value of LCR and the sensitivity and specificity of the ROC curve were 1,780.7050 and 84.6% and 66.2%, respectively. The related factors to classify COVID-19 patients into severe and critical groups included the number of comorbidities, PLT, LCR, and SOFA score. Among these factors, SOFA score showed the greatest effect, and LCR was the only protective factor. The area under the ROC curve of LCR to classify COVID-19 patients into severe and critical groups was 0.106. The cutoff value of LCR and the sensitivity and specificity of the ROC curve were 571.2200 and 81.3% and 90.0%, respectively. In summary, LCR can differentiate disease severity of COVID-19 patients and serve as a simple and objective assistant screening tool for hospital and ICU admission.

Predictive and Prognostic Potentials of Lymphocyte-C-Reactive Protein Ratio Upon Hospitalization in Adult Patients with Acute Pancreatitis

“…Importantly, a previous study from our research group demonstrated the predictive ability of LCR in adult patients with coronavirus disease 2019 (COVID-19) and its potential as an assistant screening tool for hospital and ICU admission. 14 Based on these considerations along with the novel findings from our previous study, LCR, as a combination of LYMPH and CRP, is highly regarded as a feasible and promising predictor to facilitate early risk stratification for tailored interventions, taking into account both the immune and inflammatory perspective, in adult patients with AP. Similarly, other non-specific biomarkers from CBC such as LYMPH, neutrophil–lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also associated with disease severity and adverse outcomes in adult patients with AP.…”

Dynamic lymphocyte-CRP ratio as a predictor: a single-centre retrospective study on disease severity and progression in adult COVID-19 patients

“… 36 , 37 Several studies have explored the predictive and prognostic potentials of LCR in COVID-19 patients, but neither previous nor ongoing trials have focused on dynamic changes in LCR during hospitalization. 9 , 38 , 39 This current study is the first attempt to explore the efficacy of dynamic changes in LCR on differentiating disease severity and predicting disease progression in adult patients with COVID-19.…”

“…In our previous study, lymphocyte-C-reactive protein ratio (LCR) on admission, used as an early representative biomarker reflecting the protective immune activation status of the body and the degree of systemic inflammatory response after SARS-CoV-2 invasion, could differentiate disease severity in adult patients with COVID-19, thus serving as an assistant screening tool for admission to hospital and intensive care unit (ICU). 9 Since changes in the condition of hospitalized adult patients with COVID-19 are common and frequent, and even in some cases the condition tends to deteriorate rapidly without any clinical clues and hints, dynamic changes in LCR may be a stronger clinical predictor of disease severity and progression than just a single LCR on admission. Accordingly, this current study aimed to explore the efficacy of dynamic changes in LCR on differentiating disease severity and predicting disease progression in adult patients with COVID-19.…”

COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters

“…Severe COVID-19 patients usually present with a hyperinflammatory status, and several studies have proposed CRP as a marker of cytokine storm in these patients [ 20 , 87 ]. Furthermore, as it is an acute phase reactant, it has been observed that in SARS-CoV-2 patients, an increase in its circulating levels can be detected in the very early phases of the disease [ 87 , 88 , 89 , 90 ], even before lung lesions become detectable by computer tomography [ 20 , 91 , 92 ]. Thus, it represents a very helpful tool to identify those patients needing immediate attention and closer clinical monitoring.…”

“…Moreover, CRP levels are not only an early stratification marker, but also a valuable tool to predict disease evolution, as higher CRP levels have been detected in COVID-19 progressive patients when compared to stable ones [ 20 , 91 ].…”