Prognostic implications of neutrophil‐lymphocyte ratio in COVID‐19

Abstract

Background The clinical presentation of COVID‐19 ranges from a mild, self‐limiting disease, to multiple organ failure and death. Most severe COVID‐19 cases present low lymphocytes counts and high leukocytes counts, and accumulated evidence suggests that in a subgroup of patients presenting severe COVID‐19, there may be a hyperinflammatory response driving a severe hypercytokinaemia which may be, at least in part, signalling the presence of an underlying endothelial dysfunction. In this context, available data suggest a prognostic role of neutrophil‐lymphocyte ratio (NLR) in various inflammatory diseases and oncological processes. Following this rationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may be useful in identifying patients with a poor prognosis in hospitalized COVID‐19 cases. Design A retrospective observational study performed at Hospital Universitario HM Puerta del Sur, Madrid, Spain, which included 119 patients with COVID‐19 from 1 March to 31 March 2020. Patients were categorized according to WHO R&D Expert Group. Results Forty‐five (12.1%) patients experienced severe acute respiratory failure requiring respiratory support. Forty‐seven (12.6%) patients died. Those with worse outcomes were older (P = .002) and presented significantly higher NLR at admission (P = .001), greater increase in Peak NLR (P < .001) and higher increasing speed of NLR (P = .003) compared with follow‐up patients. In a multivariable logistic regression, age, cardiovascular disease and C‐reactive protein at admission and Peak NLR were significantly associated with death. Conclusions NLR is an easily measurable, available, cost‐effective and reliable parameter, which continuous monitoring could be useful for the diagnosis and treatment of COVID‐19.

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

“…Neutrophil and lymphocyte ratio (NLR) has been proposed as a prognostic marker of severity in various chronic inflammatory diseases, including cardiovascular diseases and oncological processes 17 .…”

The cellular immune response to COVID-19 deciphered by single cell multi-omics across three UK centres

“…Neuropilin (NRP1), a cell surface receptor expressed in respiratory and olfactory epithelium, can also facilitate SARS-CoV-2 cellular entry 11 . Patients with COVID-19 infection often have lymphopenia in association with high neutrophil and platelet counts, parameters which may give prognostic indication 12 .…”

Comparative study of hematological and radiological feature of severe/critically ill patients with COVID-19, Influenza A H7N9 and H1N1 pneumonia

“…A multi-center retrospective study also reported the NLR was an independent risk factor for patient survivals in H7N9 pneumonia [4]. A retrospective observational study found that the NLR was an easily measurable, available, cost-effective and reliable parameter, which continuous monitoring may be useful for the diagnosis and treatment of COVID-19 [19]. Taken together, these results reveal that the NLR in hematological examination is an important clinical parameter for the prediction of patient prognosis in the pneumonia caused by viral infections, including the in uenza and COVID-19.…”

“…The pathogen was later identi ed to be a previously unknown beta coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. The World Health Organization (WHO) denominated the new disease as coronavirus disease 2019 (COVID- 19) in February and declared COVID-19 outbreak a pandemic in March, 2020. Until the October 1, 2020, more than 30 million con rmed COVID-19 cases have been reported globally, with more than 1,000,000 patient deaths.…”