Neutrophil‐to‐lymphocyte ratio, a critical predictor for assessment of disease severity in patients with COVID‐19

Liu, Lei; Zheng, Yaqiong; Cai, Liping; Wu, Wanlei; Tang, Shi; Ding, Yinjuan; Liu, Wanbing; Kou, Guomei; Xiong, Zhuo; Wang, Shengdian; Zheng, Shangen

doi:10.1111/ijlh.13374

Cited by 21 publications

(14 citation statements)

References 22 publications

(20 reference statements)

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“…6 Several studies reported that the NLR and PLR can be used as independent prognostic markers of disease severity in COVID-19. [17][18][19] We identified that there was no significant association of NLR and PLR values in terms of mortality of our patients. We also observed that many of the other risk factors for mortality in this cancer cohort were comparable with published data from the various epicenters of this global pandemic.…”

Section: Discussionmentioning

confidence: 59%

Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India

Roy

Ghosh

Ganguly

et al. 2021

JCO Global Oncology

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PURPOSE The COVID-19 pandemic has imposed a unique challenge to oncology patients. Outcome data on COVID-19 in patients with cancer from the Indian subcontinent are scarce in the literature. We aimed to evaluate the outcome of patients with COVID-19 on active systemic anticancer therapy. MATERIALS AND METHODS This is a retrospective study of patients with solid organ malignancies undergoing systemic therapy with a diagnosis of COVID-19 between March 2020 and February 2021. COVID-19 was diagnosed if a reverse transcriptase polymerase chain reaction assay from oropharyngeal or nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2. The objectives were to evaluate the outcome of COVID-19 and factors predicting the outcome. RESULTS A total of 145 patients were included with a median age of 58 years (range, 20-81 years). Treatment was curative in 60 (42%) patients. Of all symptomatic cases (n = 88, 61%), 50 had mild, 27 had moderate and 19 had severe COVID-19–related symptoms as per WHO criteria. Fifty (34%) patients required hospitalization with a median duration of hospital stay of 12 days (range, 4-25 days); five patients required intensive care unit admission. The rest were treated with home isolation and did not require further hospitalization. Twenty-two (15%) patients died, and the risk of death was significantly associated with severity of symptoms (odds ratio, 91.3; 95% CI, 9.1 to 919.5, P = .0001) but not with any other clinical factors. Drug holiday was given to 63 (44%) patients with a median duration of 25 days (range, 7-88 days). The median duration to reverse transcriptase polymerase chain reaction–negative was 16 days (range, 7-62 days). CONCLUSION COVD-19–related death rate was 15% among patients with solid organ malignancies. The severity of the symptoms was related to mortality. The majority of patients with mild symptoms were treated at home isolation.

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Section: Discussionmentioning

confidence: 59%

Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India

Roy

Ghosh

Ganguly

et al. 2021

JCO Global Oncology

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“…Many studies have reported that the neutrophil-to-lymphocyte ratio (NLR) can predict severe disease. [9][10][11][12][13][14] However, most of the studies were retrospective, and the optimal NLR cut-off point is lacking.…”

Section: Introductionmentioning

confidence: 99%

Validation of Neutrophil-to-Lymphocyte Ratio Cut-off Value Associated with High In-Hospital Mortality in COVID-19 Patients

Yıldız¹,

Castanares-Zapatero²,

Pierman³

et al. 2021

IJGM

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The neutrophil-to-lymphocyte ratio (NLR) could be a predictive factor of severe COVID-19. However, most relevant studies are retrospective, and the optimal NLR cut-off point has not been determined. The objective of our research was identification and validation of the best NLR cut-off value on admission that could predict high in-hospital mortality in COVID-19 patients. Methods: Medical files of all patients admitted for COVID-19 pneumonia in our dedicated COVID-units between March and April 2020 (derivation cohort) and between October and December 2020 (validation cohort) were reviewed. Results: Two hundred ninety-nine patients were included in the study (198 in the derivation and 101 in the validation cohort, respectively). Youden's J statistic in the derivation cohort determined the optimal cut-off value for the performance of NLR at admission to predict mortality in hospitalized patients with COVID-19. The NLR cut-off value of 5.94 had a sensitivity of 62% and specificity of 64%. In ROC curve analysis, the AUC was 0.665 [95% CI 0.530-0.801, p= 0.025]. In the validation cohort, the best predictive cut-off value of NLR was 6.4, which corresponded to a sensitivity of 63% and a specificity of 64% with AUC 0.766 [95% CI 0.651-0.881, p <0.001]. When the NLR cut-off value of 5.94 was applied in the validation cohort, there was no significant difference in death and survival in comparison with the derivation NLR cut-off. Net reclassification improvement (NRI) analysis showed no significant classification change in outcome between both NLR cut-off values (NRI:0.012, p=0.31). Conclusion:In prospective analysis, an NLR value of 5.94 predicted high in-hospital mortality upon admission in patients hospitalized for COVID-19 pneumonia.

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“…The validity and robustness of the statistical analysis models were verified through goodness-of-fit, bivariate normality, and influence analyses, as well as the outlier detection method. The results obtained by eliminating these anomalies [ 12 , 17 , 19 , 30 , 31 ] did not differ significantly compared to the previous outcomes (AUC = 0.85).…”

Section: Resultsmentioning

confidence: 70%

“…The diagnosis of COVID-19 was confirmed in all cases. The studies were conducted in China [ 8 – 13 , 15 , 16 , 18 , 19 , 21 – 23 , 25 , 31 – 34 ], Pakistan [ 28 ], Argentina [ 20 ], Turkey [ 14 , 17 , 33 , 35 ], Saudi Arabia [ 24 ], Iran [ 27 , 36 ], and Egypt [ 29 , 30 ]. The studies were conducted at a single center, with the exception of two multicenter studies [ 12 , 13 , 24 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

Value of the Neutrophil-Lymphocyte Ratio in Predicting COVID-19 Severity: A Meta-analysis

Wang

Zhao²,

Yang³

et al. 2021

Disease Markers

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Background. Coronavirus disease 2019 (COVID-19) is highly contagious and continues to spread rapidly. However, there are no simple and timely laboratory techniques to determine the severity of COVID-19. In this meta-analysis, we assessed the potential of the neutrophil-lymphocyte ratio (NLR) as an indicator of severe versus nonsevere COVID-19 cases. Methods. A search for studies on the NLR in severe and nonsevere COVID-19 cases published from January 1, 2020, to July 1, 2021, was conducted on the PubMed, EMBASE, and Cochrane Library databases. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and area under the curve (AUC) analyses were done on Stata 14.0 and Meta-disc 1.4 to assess the performance of the NLR. Results. Thirty studies, including 5570 patients, were analyzed. Of these, 1603 and 3967 patients had severe and nonsevere COVID-19, respectively. The overall sensitivity and specificity were 0.82 (95% confidence interval (CI), 0.77-0.87) and 0.77 (95% CI, 0.70-0.83), respectively; positive and negative correlation ratios were 3.6 (95% CI, 2.7-4.7) and 0.23 (95% CI, 0.17-0.30), respectively; DOR was 16 (95% CI, 10-24), and the AUC was 0.87 (95% CI, 0.84-0.90). Conclusion. The NLR could accurately determine the severity of COVID-19 and can be used to identify patients with severe disease to guide clinical decision-making.

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Neutrophil‐to‐lymphocyte ratio, a critical predictor for assessment of disease severity in patients with COVID‐19

Cited by 21 publications

References 22 publications

Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India

Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India

Validation of Neutrophil-to-Lymphocyte Ratio Cut-off Value Associated with High In-Hospital Mortality in COVID-19 Patients

Value of the Neutrophil-Lymphocyte Ratio in Predicting COVID-19 Severity: A Meta-analysis

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