The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis

Alkhatip, Ahmed Abdelaal Ahmed Mahmoud M.; Kamel, Mohamed Gomaa; Hamza, M; Farag, Ehab; Yassin, Hany Mahmoud; Elayashy, Mohamed; Naguib, Amr Ahmed; Wagih, Mohamed; Abd‐Elhay, Fatma Abd‐Elshahed; Algameel, Haytham Zien; Yousef, Mohammed; Purcell, Andrew; Helmy, Mohamed

doi:10.1080/14737159.2021.1915773

Cited by 47 publications

(42 citation statements)

References 84 publications

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“…Neutrophil-to-lymphocyte ratios (NLR) have been used extensively in clinics as biomarkers for disease severity, with higher ratios usually associated with more severe inflammation and disease outcome. 25 – 27 To determine whether opioid exposure affected NLRs in neonates, we performed a secondary analysis of cell populations that revealed a decreased NLR in the opioid-exposed group (Fig. 2a ).…”

Section: Resultsmentioning

confidence: 99%

The impact of opioid exposure during pregnancy on the human neonatal immune profile

et al. 2022

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Background The increasing magnitude of the opioid crisis and rising rates of neonatal abstinence syndrome (NAS) diagnoses highlight the need for increased research into how maternal substance use during pregnancy can impact the neonatal immune profile and its functionality. We hypothesized that neonates with opioid exposure would have reduced proportions of some immune cells, an anti-inflammatory cytokine profile, reduced T cell proliferation, and monocyte bacterial killing activity compared to the control population. Methods The present study compares immune cell populations, inflammatory and anti-inflammatory cytokine and chemokine levels in the serum, and monocyte and T cell functional activity using umbilical cord samples from neonates with known opioid exposure during gestation and from control neonates without known exposure. Results Our findings demonstrated a significant reduction in neutrophils, decreased levels of inflammatory cytokines in the serum, and reduced IL-2 production during in vitro CD4 + T cell proliferation in neonates exposed to opioids compared to controls. The neutrophil findings were supported by retrospective analysis of an extended network of deidentified patient records. Conclusions This study is the first of its kind to evaluate differences in neonatal immunity as a result of opioid exposure in the human population that will inform continued mechanistic studies. Impact The opioid epidemic has become a public health crisis in the United States, and the corresponding incidence of neonatal abstinence syndrome (NAS) have risen accordingly. New research is required to understand the short and long-term health impacts of opioid exposure to the neonate. This is the first human study to investigate the immunologic profile and functionality in neonates with known opioid exposure in utero. The abundance of neutrophils and the ratio of neutrophils to lymphocytes is significantly reduced along with inflammatory cytokines and chemokines following opioid exposure during pregnancy. The immune profile in opioid-exposed neonates may promote susceptibility to infection.

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Section: Resultsmentioning

confidence: 99%

The impact of opioid exposure during pregnancy on the human neonatal immune profile

et al. 2022

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“…The neutrophil-to-lymphocyte ratio (NLR) is an attractive biomarker of systemic inflammation because it is easily calculated from the absolute neutrophil and lymphocyte counts collected from a routine complete blood cell count with differentials [ 17 ]. NLR as an inflammatory marker also has prognostic value for cardiovascular diseases, cancers, and COVID-19 [ 18 , 19 , 20 ]. Although a previous study assessed the relationship between NKA and inflammatory markers, especially NLR [ 21 ], the number of subjects was relatively small, and the range of NKA distribution was narrow.…”

Section: Introductionmentioning

confidence: 99%

Cross-Sectional and Time-Dependent Analyses on Inflammatory Markers following Natural Killer Cell Activity

et al. 2022

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The function of natural killer (NK) cells in inflammation has not been explored enough in large-scale population studies. The cross-sectional and time-dependent relationship between NK cell activity (NKA) and inflammatory markers was examined. Methods: A total of 7031 subjects were involved in the cross-sectional analyses. Non-linear relationship between NKA and inflammatory indices was analyzed using generalized additive models. The time-dependent changes were analyzed in 1005 subjects with repeated measurement in 3–6 months. The changes in inflammatory markers were analyzed based on the changes in NKA. Results: As NKA reduces to a very low level, the white blood cell (WBC) and neutrophil counts increase sharply, and the lymphocyte count exhibits a slow decline. With increasing NKA larger than about 500 pg/mL, WBC and neutrophil-lymphocyte ratio (NLR) reduces in a mild slope. Among the subjects with repeated measurements, the follow-up NKA was increased with advancing baseline NKA levels. The subjects with a reduction in NKA indicated increment in WBC count, neutrophil count, and NLR, and decrease in lymphocyte count. Conclusions: Very low levels of NKA suggest a high inflammatory immune response. The changes in NKA may interact with the balance between neutrophils and lymphocytes.

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“…A high neutrophil-to-lymphocyte ratio (NLR) as well as T cell lymphopenia, especially decreased CD4 + T cells have been reported in the majority of COVID-19 patients and particularly among the severe cases (Peng et al 2020 ). In concert with these findings, NLR has been indicated as an independent risk factor for severe COVID-19 (Alkhatip et al 2021 ; Cai et al 2021 ; Zeng et al 2021 ; Liu et al 2020 ), Considering the important role of pro-inflammatory pathways in COVID-19 pathology, several natural compounds with anti-inflammatory and immunomodulatory effects have been proposed as potential adjunctive therapy in conjunction with anti-viral drugs used in the current standard of care treatment (Ho et al 2021 ). There is a large body of evidence suggesting that Boswellic acids (BAs), the main pharmacologically active triterpenoids derived from the resin of Boswellia spp.…”

Section: Introductionmentioning

confidence: 94%

Inflawell® improves neutrophil-to-lymphocyte ratio and shortens hospitalization in patients with moderate COVID-19, in a randomized double-blind placebo-controlled clinical trial

Tond

Balenci²,

Khajavirad

et al. 2022

Inflammopharmacol

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Aims COVID-19 is a significant global threat to public health. Despite the availability of vaccines and anti-viral drugs, there is an urgent need for alternative treatments to help prevent and/or manage COVID-19 symptoms and the underlying dysregulated immune response. We hypothesized that administration of Inflawell ® syrup, a Boswellia extract formulation enriched for boswellic acids (BAs), can reduce the excessive or persistent inflammation and thereby prevent disease progression. BAs are medicinally activated triterpenoids found in the resins of Boswellia spp ., and possess an immense therapeutic potential due to their anti-inflammatory and immunoregulatory activities. We investigated the effect of Inflawell ® syrup, on moderate COVID-19 patients along with the current standard of care treatment. Methods A randomized placebo-controlled double-blind clinical trial was conducted, following definitive confirmation of COVID-19. Forty-seven hospitalized patients with moderate COVID-19 were enrolled and received either the Inflawell ® syrup or placebo. Clinical symptoms and markers of inflammation were evaluated at baseline and completion of the trial. Results Our clinical trial revealed an increase in the percentage of oxygen saturation level in patients that received the BAs compared to placebo ( P < 0.0001). In addition, the average duration of hospitalization was significantly shorter in the BAs group compared with the placebo group ( P < 0.04). Concomitantly, some improvement in the clinical symptoms including cough, dyspnea, myalgia, headache, and olfactory and gustatory dysfunction were detected in the BAs group. Hematologic findings showed a significant decrease in the percentage of neutrophils ( P < 0.006) and neutrophil-to-lymphocyte ratio (NLR) levels ( P < 0.003), associated with a significant increase in the percentage of lymphocytes in the BAs group compared with the placebo ( P < 0.002). Additionally, a significant decrease in CRP, LDH, IL − 6 and TNF − α levels was detected in the BAs group. Following the intervention, fewer patients in the BAs group were PCR-positive for COVID-19 compared to placebo, though not statistically significant. Conclusion Overall, the treatment with Inflawell ® resulted in shorter hospital stay, alleviation of COVID-19 clinical symptoms and decline in the level of pro-inflammatory cytokines. Trial registration The trial has been registered in https://www.irct.ir with unique identifier: IRCT20170315033086N10 ( https://en.irct.ir/trial/51631 ). IRCT is a primary registry in the WHO registry network ( https://www...

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The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis

Cited by 47 publications

References 84 publications

The impact of opioid exposure during pregnancy on the human neonatal immune profile

The impact of opioid exposure during pregnancy on the human neonatal immune profile

Cross-Sectional and Time-Dependent Analyses on Inflammatory Markers following Natural Killer Cell Activity

Inflawell® improves neutrophil-to-lymphocyte ratio and shortens hospitalization in patients with moderate COVID-19, in a randomized double-blind placebo-controlled clinical trial

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