Neutrophil count predicts clinical outcome in hospitalized COVID‐19 patients: Results from the NOR‐Solidarity trial

Abstract

Despite numerous studies on SARS-CoV-2induced inflammation, we still lack markers for rapid disease progression with admission to intensive care unit (ICU) or respiratory failure (RF). Few studies have evaluated the prognostic value of routine diagnostic repertoire available at most hospitals. The NOR-Solidarity trial is an independent add-on study to the WHO Solidarity trial, evaluating hydroxychloroquine (HCQ) and remdesivir compared to standard of care in hospitalized COVID-19 patients [1]. We explored whether standard biomarkers in peripheral blood could give information on ICU admission and RF in hospitalized COVID-19 patients.Adult patients admitted to 23 Norwegian hospitals with PCR-confirmed SARS-2-CoV-2 infection were eligible for participation. In this substudy, the routine biochemistry was related to (i) the need for ICU admission or (ii) RF defined as pO 2 /FiO 2 (P/F ratio) < 26.6 kPa during the first 10 days of hospitalization. Routine peripheral blood samples were collected at inclusion and daily until discharge from the hospital, and outpatients were followed up 3 months after discharge. Markers included were C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), haemoglobin, fibrinogen, procalcitonin (PCT), D-dimer, platelet count, total white blood cell count, monocyte, neutrophil and lymphocyte count. Exclusion criteria, intervention, ethical statement, details on viral load and SARS-CoV-2 antibodies and statistical analysis are given in the Supporting Information file.

Persistent T‐cell exhaustion in relation to prolonged pulmonary pathology and death after severe COVID‐19: Results from two Norwegian cohort studies

“…In the present study, however, we found no effects of comorbidities including chronic cardiac or pulmonary disease, hypertension, obesity, or diabetes, or any effect of accumulated comorbidities on levels of sTim‐3 and sCD25, further supporting that these markers reflect distinct COVID‐19 pathology. To this end, several markers of disease severity have been established in hospitalized COVID‐19 patients, such as CRP and high neutrophil and low lymphocyte counts [ 28 ]. These factors were, therefore, adjusted for in the present study without having a major influence on the results.…”

Antibody therapy reverses biological signatures of COVID-19 progression

“…NLR, the simple ratio of neutrophil over lymphocyte counts, could be informative and easy to implement, an observation supported by other studies. 17 , 18 , 19 Though NLR sensitivity is low, the high specificity suggests that high NLR could be used as a triage test for persons at high risk of progressing and could prioritize those individuals for closer monitoring.…”

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…Another study found an association between procalcitonin and mortality in COVID-19 patients more than 75 years old ( 34 ). Neutrophil count was also predictive of clinical outcome in hospitalized COVID-19 patients ( 35 ), while the neutrophil-to-lymphocyte ratio was strongly associated with severity and mortality in COVID-19 ( 36 ). Additionally, total lymphocyte count, cluster differentiation (CD)3 + , CD4 + , CD8 + , CD25 + , CD127 – T cells, and natural killer (NK) cells were found to be depressed in severe COVID-19 ( 37 ), whereas C-reactive protein, erythrocyte sedimentation rate, and IL-6 – common markers of inflammation – were elevated ( 38 ).…”