Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

Abstract

Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

MPR and NLR as Prognostic Markers in ICU-Admitted Patients with COVID-19 in Jazan, Saudi Arabia

“…Several studies have examined NLR, which is a calculated parameter derived from the proportion of neutrophils and lymphocytes, as a predictive marker for the diagnosis and prediction of the severity and mortality of COVID-19. 18 , 30 , 33 , 34 The current study shows that increased NLR is associated with poor outcomes in severely infected COVID-19 patients, as demonstrated by the high NLR values in the PA group compared to the DC group. A recent study carried out in Saudi Arabia demonstrated that COVID-19 patients in the ICU had significantly higher NLR values than non-ICU patients and healthy controls.…”

“… 9 Our data showed an association between increased risk of COVID-19 mortality and increased MPR and NLR values, which is similar to previous reports related to the hospitalization, severity, and mortality of COVID-19 patients. 18 , 25 , 26 , 30 , 33 , 37 …”

Assessment of COVID-19 progression on day 5 from symptoms onset

“…A systematic review of ten prognostic models revealed that the most reported predictors of disease progression and mortality were age, sex, CRP, LDH and lymphocyte count [ 9 ]. Recently, the predictive value of NLR measured at hospital admission has been assessed in a prospective cohort, showing a high value in predicting disease deterioration, shock and death (all the areas under the curve > 0.80) [ 13 ]. The vast majority of these models assessed the predictors by considering the hospital admission as baseline time-point [ 10 – 13 ], and share therefore the common drawback of including patients at varying stages of the disease.…”

Comparing between survived and deceased patients with Diabetes Mellitus and COVID-19 in Bangladesh: A cross sectional study from a COVID-19 dedicated hospital

“…Highly elevated NLR and serum ferritin essentially indicate excessive inflammation leading to cytokine storm and multiple organ damage in patients with COVID-19. Significantly higher NLR and serum ferritin levels among non-survivors compared to survivors were reported in already published studies [10,11].…”