Neutrophil Percentage and Neutrophil-to-Monocyte Ratio as Independent Risk Factors in the Severity of COVID-19

Abstract

BackgroundInflammation plays an important role in progression of the various viral pneumonia containing COVID-19, severe inflammatory responses could lead to an imbalance of immune response. The purpose of this study was to explore the possibility of the white blood count, neutrophil percentage, neutrophil-to-monocyte ratio (NMR) and neutrophil-to-lymphocyte ratio (NLR) at admission to reflect the clinical severity in patients with COVID‐19.MethodsClinical and laboratory data of adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease severity and related risk factors. The receiver operating characteristic (ROC) curve was utilized to analyze the abilities of potential risk factors in the prediction of COVID-19 severity.ResultsCompared with non-severe patients, the severe ones had significantly higher levels of neutrophil percentage (74.9% vs. 62.1%; P < 0.001), NLR (4.1 vs. 2.1; P < 0.001) and NMR (12.4 vs. 8.0; P < 0.001). A regression analysis showed that neutrophil percentage (OR,1.113; 95% CI, 1.020-1.213; P=0.016) and NMR (OR, 1.110; 95% CI, 1.002-1.230; P = 0.046) were significantly associated with severity of COVID-19 patients. ROC curve showed that the area under the curves of neutrophil percentage, NMR and the combination of them were 0.842 (95% confidence interval (CI), 0.782-0.902), 0.790 (95% CI, 0.710-0.871) and 0.851 (95% CI, 0.790-0.911), respectively.ConclusionsNeutrophil percentage and NMR may act as independent risk factors in the severity of COVID-19.

The Impact of Neutrophil-Lymphocyte Count Ratio in COVID-19: A Systematic Review and Meta-Analysis

“…A total of 90 studies 22 – 111 (82 retrospectives, 5 prospective, 3 cross-sectional) out of 7352 identified publications were included after satisfying the inclusion criteria ( Figure 1 ). While 44 articles 41 , 42 , 44 , 46 , 47 , 49 , 50 – 71 , 73 – 76 , 78 – 80 , 101 , 103 – 106 , 108 – 111 assessed baseline NLR as a predictor for determining only severity, 32 articles 24 , 25 , 29 – 34 , 38 – 40 , 43 , 45 , 48 , 77 , 82 – 93 , 96 – 98 , 100 , 102 assessed only mortality, 14 studies 22 , 23 , 26 – 28 , 35 – 37 , 72 , 81 , 94 , 95 , 99 , 107 addressed both sur...…”

“…A total of 90 studies 22–111 (82 retrospectives, 5 prospective, 3 cross-sectional) out of 7352 identified publications were included after satisfying the inclusion criteria (Figure 1). While 44 articles 41,42,44,46,47,49,50–71,73–76,78–80,101,103–106,108–111 assessed baseline NLR as a predictor for determining only severity, 32 articles 24,25,29–34,38–40,43,45,48,77,82–93,96–98,100,102 assessed only mortality, 14 studies 22,23,26–28,35–37,72,81,94,95,99,107 addressed both survivability and severity. Out of the 46 articles, assessed survivability 36 were with only dichotomous data, 10 with only receiver operating curve, and 11 with both types of data.…”

“…A total of 90 studies (82 retrospectives, 5 prospective, 3 cross-sectional) out of 7352 identified publications were included after satisfying the inclusion criteria (Figure 1). While 44 articles 41,42,44,46,47,49,[73][74][75][76][78][79][80]101,[103][104][105][106][108][109][110][111] assessed baseline NLR as a predictor for determining only severity, 32 articles 24,25,[29][30][31][32][33][34][38][39][40]43,45,48,77,[82][83][84][85][86][87][88][89][90][91][92]…”

Laboratory Findings In Predicting Intensive Care Need And Death Of COVID-19 Patients

“…Rizo-Téllez et al [15] found an NMR >17.75 to be a good independent risk factor for predicting mortality with a sensitivity of 89.4% and a specificity of 80%. Peng et al [16] found that NMR was significantly associated with the severity of COVID-19 (12.4 vs. 8.0 in severe and non-severe patients; p<0.001). In this study, the NMR value was found to be significant in both univariate and multivariate analysis as a predictor of the need for intensive care.…”