Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line

Ciccullo, Arturo; Borghetti, Alberto; Verme, Lorenzo Zileri Dal; Tosoni, Alberto; Lombardi, Francesca; Garcovich, Matteo; Biscetti, Federico; Montalto, Massimo; Cauda, Roberto; Giambenedetto, Simona Di

doi:10.1016/j.ijantimicag.2020.106017

Cited by 116 publications

(102 citation statements)

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“…Neutrophil to Lymphocyte ratio (NLR) has been explored as a prognostic marker for COVID-19, with high level of NLR associated with severity of the disease 43,44 or with higher mortality rates 45,46 . More specific subsets of the Lymphocytes, especially the CD4 + and CD8 + T-cell counts are found to be depleted in severe COVID-19 patients 17,47 .…”

Section: Relationship With Immune Cellsmentioning

confidence: 99%

IL-6 and IL-10 as predictors of disease severity in COVID-19 patients: results from meta-analysis and regression

Dhar¹,

Vishnupriyan²,

Damodar³

et al. 2020

Preprint

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Objectives: SARS-CoV-2, an infectious agent behind the ongoing COVID-19 pandemic, induces high levels of cytokines in patients contributing to the disease patho-physiology. Nonetheless, exact association and contribution of particular cytokines towards COVID-19 pathology remains poorly understood. This study performed a comprehensive meta-analysis to establish association between induced cytokines and COVID-19 disease severity to help in prognosis and clinical management. Methods: Scientific literature was searched to identify 18 clinical studies. Standardized mean difference (SMD) for cytokines IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ between severe and non-severe COVID-19 patient groups were summarized using random effects model. A classifier was built using logistic regression model with cytokines having significant SMD as covariates. Results: Out of the 6 cytokines, IL-6 and IL-10 showed statistically significant SMD across the studies synthesized. Classifier with mean values of both IL-6 and IL-10 as covariates performed well with accuracy of ~ 92% that was significantly higher than accuracy reported in literature with IL-6 and IL-10 as individual covariates. Conclusions: Simple panel proposed by us with only two cytokine markers can be used as predictors for fast diagnosis of patients with higher risk of COVID-19 disease deterioration and thus can be managed well for a favourable prognosis.

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Section: Relationship With Immune Cellsmentioning

confidence: 99%

IL-6 and IL-10 as predictors of disease severity in COVID-19 patients: results from meta-analysis and regression

Dhar¹,

Vishnupriyan²,

Damodar³

et al. 2020

Preprint

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show abstract

“…Various parameters have been proposed to predict prognosis and outcomes among patients with COVID, including the neutrophil to lymphocyte ratio (NLR) (27)(28)(29)(30). A metanalysis of six studies involving 1,141 patients has demonstrated that an elevated NLR is associated with severe disease manifestation (28).…”

Section: Introductionmentioning

confidence: 99%

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

2020

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Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.

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“…Another Chinese study performed in Hubei Provincial Hospital of Integrated Chinese and Western Medicine included 32 moderate and 31 severe cases and found an optimal cut-off of NLR >4.7 is an independent risk factor for severe COVID-19 [ 7 ]. Afterward, a European study conducted in Italy showed that severe patients are also older and had higher NLR compared with non-severe patients, suggesting that NLR may be a useful marker to early screening of COVID-19 patients [ 8 ]. Surprisingly, the risk of in-hospital mortality is 8% higher for each unit increase of NLR (OR: 1.08, 95%CI: 1.01–1.14), and patients from tertile 3 (NLR 4.85–88.09) have a 15-fold higher risk of death than patients from tertile 1 (NLR 0.54–2.21) [ 9 ].…”

mentioning

confidence: 99%