Neutrophil‐to‐lymphocyte ratio is independently associated with COVID‐19 severity: An updated meta‐analysis based on adjusted effect estimates

Li, Yang; Hou, Hongjie; Diao, Jie; Wang, Yadong; Yang, Haiyan

doi:10.1111/ijlh.13475

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…NLR levels were significantly higher in both deceased and not improved groups. High NLR level at the administration of TCZ is, therefore, a significant risk factor for mortality in our population, which is consistent with a meta-analysis conducted by Li et al among 34 studies with COVID-19 patients and was also reported by Ahsan et al that high NLR level was a strong predictor of death among COVID-19 patients [ 32 , 33 ].…”

Section: Discussionsupporting

confidence: 91%

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

Alex

Gulam

Kumar

2022

Advances in Virology

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Introduction. Coronavirus disease 2019 (COVID-19) can progress to severe respiratory compromise and lead to mortality due to induction of cytokine storm. Tocilizumab (TCZ) is approved by the FDA for the treatment of cytokine release syndrome (CRS). This study aims to analyze the outcomes among patients who received TCZ in the United Arab Emirates. Methods. A retrospective cohort study was conducted among COVID-19 patients who received TCZ in a tertiary care hospital from May 2020 to August 2021. For analysis, patients were divided into two groups based on survival and clinical improvement. Results. Overall, 80% of patients receiving TCZ were discharged by day 28. There was a gradual improvement in oxygen requirements in our patients with a majority of them on room air by day 28. Age more than 50 years ( P = 0.034 ) and comorbidities such as cardiovascular disease (CVD) ( P = 0.002 ) and renal insufficiency ( P = 0.013 ) were significantly associated with mortality. Discussion. In our analysis, patients who were mechanically ventilated at the time of administration of TCZ had a significantly higher risk of death by day 28. In both survived and improved groups, younger patients had better outcomes than older patients. Patients who received TCZ earlier during therapy from the onset of symptoms had better survival outcomes. There was only one death among 14 patients who received vaccination. There was no significant difference in mortality among patients with comorbidities such as diabetes, hypertension, dyslipidemia, obesity, and pulmonary diseases, hypothesizing that administration of TCZ improves the outcomes in COVID-19 patients with these comorbidities.

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Section: Discussionsupporting

confidence: 91%

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

Alex

Gulam

Kumar

2022

Advances in Virology

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“…Li et al 10 included 19 studies in their meta-analysis, and only one was prospective. Li et al 25 found, in a meta-analysis including 34 studies (25,074 COVID-19 patients) that high NLR was an independent risk factor for high mortality. Thirteen studies (1579 patients) found that NLR was predictive of disease severity with an AUC 0.85 (95% CI 0.81-0.88).…”

Section: Discussionmentioning

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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“…NLR has been extensively studied in many infectious diseases. It has been identified that the NLR in COVID-19 may be a proper prognostic parameter [26,44,49,50]. Our study found that among hematologic ratios, the NLR was elevated in COVID-19 patients compared with dengue patients.…”

Section: Discussionmentioning

confidence: 46%

The Usefulness of Peripheral Blood Cell Counts to Distinguish COVID-19 from Dengue during Acute Infection

et al. 2022

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COVID-19 and dengue disease are challenging to tell apart because they have similarities in clinical and laboratory features during the acute phase of infection, leading to misdiagnosis and delayed treatment. The present study evaluated peripheral blood cell count accuracy to distinguish COVID-19 non-critical patients from non-severe dengue cases between the second and eleventh day after symptom onset. A total of 288 patients infected with SARS-CoV-2 (n = 105) or dengue virus (n = 183) were included in this study. Neutrophil, platelet, and lymphocyte counts were used to calculate the neutrophil–lymphocyte ratio (NLR), the platelet–lymphocyte ratio (PLR), and the neutrophil–lymphocyte*platelet ratio (NLPR). The logistic regression and ROC curves analysis revealed that neutrophil and platelet counts, NLR, LPR, and NLPR were higher in COVID-19 than dengue. The multivariate predictive model showed that the neutrophils, platelets, and NLPR were independently associated with COVID-19 with a good fit predictive value (p = 0.1041). The neutrophil (AUC = 0.95, 95% CI = 0.84–0.91), platelet (AUC = 0.89, 95% CI = 0.85–0.93) counts, and NLR (AUC = 0.88, 95% CI = 0.84–0.91) were able to discriminate COVID-19 from dengue with high sensitivity and specificity values (above 80%). Finally, based on predicted probabilities on combining neutrophils and platelets with NLR or NLPR, the adjusted AUC was 0.97 (95% CI = 0.94–0.98) to differentiate COVID-19 from dengue during the acute phase of infection with outstanding accuracy. These findings might suggest that the neutrophil, platelet counts, and NLR or NLPR provide a quick and cost-effective way to distinguish between dengue and COVID-19 in the context of co-epidemics in low-income tropical regions.

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Neutrophil‐to‐lymphocyte ratio is independently associated with COVID‐19 severity: An updated meta‐analysis based on adjusted effect estimates

Cited by 7 publications

References 14 publications

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

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

The Usefulness of Peripheral Blood Cell Counts to Distinguish COVID-19 from Dengue during Acute Infection

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