Vol 31, No 3 (2024)
Original Article
Published online: 2023-12-27

open access

Page views 988
Article views/downloads 272
Get Citation

Connect on Social Media

Connect on Social Media

The role of the neutrophil-lymphocyte ratio in predicting poor outcomes in COVID-19 patients

Raymond Farah12, Rola Khamisy-Farah23, Kacper Dziedzic4, Ewa Skrzypek5, Michal Pruc67, Nicola Luigi Bragazzi8, Lukasz Szarpak49, Mahmoud Jomah2
Pubmed: 38149489
Cardiol J 2024;31(3):374-380.

Abstract

Background: This study examines how the neutrophil-lymphocyte ratio (NLR) predicts coronavirus disease 2019 (COVID-19) hospitalization, severity, length, and mortality in adult patients.

Methods: A study was done using a retrospective, single-center, observational design. A total of 400 patients who were admitted to the Ziv Medical Center (Safed, Israel) from April 2020 to December 2021 with a confirmed diagnosis of COVID-19 through RT-PCR testing were included in the analysis. Two complete blood count laboratory tests were conducted for each patient. The first test was administered upon admission to the hospital, while the second test was conducted prior to the patient’s discharge from the hospital or a few days before their death.

Results: Four hundred patients were included in the study, 206 males (51.5%) and 194 females (48.5%). The mean age was 64.5 ± 17.1 years. In the group of cases, there were 102 deaths, and 296 survivors were recorded, with a fatality rate of 25.5%. The median NLR was 6.9 ± 5.8 at the beginning of hospitalization and 15.1 ± 32.9 at the end of hospitalization (p < 0.001). The median length of hospital stay was 9.4 ± 8.8 days. NLR in the fatality group was 34.0 ± 49.9 compared to 8.4 ± 20.4 in the survivor group (p < 0.001). Comparison between the NLR at the time of admission of the patient and before discharge/death was 6.9 ± 5.8 vs. 15.1 ± 32.9 (p < 0.001).

Conclusions: The analyses conducted revealed a statistically significant correlation between the NLR and the severity, mortality rates, and the duration of hospitalization. The consideration of NLR should commence during the initial phases of the disease when assessing individuals afflicted with COVID-19.

Article available in PDF format

View PDF Download PDF file

References

  1. Smereka J, Szarpak L, Filipiak K. Modern medicine in COVID-19 era. Disaster Emerg Med J. 2020; 5(2): 103–105.
  2. Dzieciatkowski T, Szarpak L, Filipiak KJ, et al. COVID-19 challenge for modern medicine. Cardiol J. 2020; 27(2): 175–183.
  3. Hernandez Acosta RA, Esquer Garrigos Z, Marcelin JR, et al. COVID-19 pathogenesis and clinical manifestations. Infect Dis Clin North Am. 2022; 36(2): 231–249.
  4. Katipoğlu B, Sönmez LÖ, Vatansev H, et al. Can hematological and biochemical parameters fasten the diagnosis of COVID-19 in emergency departments? Disaster Emerg Med J. 2020; 5(4): 175–181.
  5. Szarpak L, Pruc M, Filipiak KJ, et al. Myocarditis: A complication of COVID-19 and long-COVID-19 syndrome as a serious threat in modern cardiology. Cardiol J. 2022; 29(1): 178–179.
  6. Dubey L, Dorosh O, Dubey N, et al. COVID-19-induced coagulopathy: Experience, achievements, prospects. Cardiol J. 2023; 30(3): 453–461.
  7. Karim S, Eidizadeh M, Kazemi M, et al. Risk factors related to COVID-19 survival and mortality: a cross-sectional-descriptive study in regional COVID-19 registry in Fasa, Iran. Disaster Emerg Med J. 2023.
  8. Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol. 2021; 93(1): 250–256.
  9. Nasheda S, Navolokina A, Hrytsan I. Biomarkers levels indicate COVID-19 severity and fatality. Disaster Emerg Med J. 2023; 8(2): 122–123.
  10. Matuszewski M, Afolabi AA, Ilesanmi OS, et al. Associations between Interleukin-4 and COVID-9 severity: A systematic review and meta-analysis. J Health Soc Sci. 2022; 7(4): 381–396.
  11. Szarpak Ł, Nowak B, Kosior D, et al. Cytokines as predictors of COVID-19 severity: evidence from a meta-analysis. Pol Arch Intern Med. 2021; 131(1): 98–99.
  12. Fajgenbaum DC, June CH, Fajgenbaum DC, et al. Cytokine storm. N Engl J Med. 2020; 383(23): 2255–2273.
  13. Knoll R, Schultze JL, Schulte-Schrepping J. Monocytes and macrophages in COVID-19. Front Immunol. 2021; 12: 720109.
  14. Matuszewski M, Szarpak L, Pruc M. A comprehensive review and meta-analysis of the relationships between interleukin-7 levels and COVID-9 severity. J Health Soc Sci. 2023; 8(1): 33–44.
  15. Fialek B, Pruc M, Smereka J, et al. Diagnostic value of lactate dehydrogenase in COVID-19: A systematic review and meta-analysis. Cardiol J. 2022; 29(5): 751–758.
  16. Szarpak L, Zaczynski A, Kosior D, et al. Evidence of diagnostic value of ferritin in patients with COVID-19. Cardiol J. 2020; 27(6): 886–887.
  17. Symonets Y, Tuboltseva O, Al-Jeabory M, et al. C-reactive protein in COVID-19 patients. Disaster Emerg Med J. 2023; 8(2): 124–125.
  18. Kilic M, Hokenek UD. Association between D-dimer and mortality in COVID-19 patients: a single center study from a Turkish hospital. Disaster Emerg Med J. 2022; 7(4): 225–230.
  19. Ruetzler K, Szarpak Ł, Ładny JR, et al. D-dimer levels predict COVID-19 severity and mortality. Kardiol Pol. 2021; 79(2): 217–218.
  20. Selders GS, Fetz AE, Radic MZ, et al. An overview of the role of neutrophils in innate immunity, inflammation and host-biomaterial integration. Regen Biomater. 2017; 4(1): 55–68.
  21. Zhou Y, Zhang M, Wu X, et al. Platelet-albumin-bilirubin score and neutrophil-to-lymphocyte ratio predict intensive care unit admission in patients with end-stage kidney disease infected with the Omicron variant of COVID-19: a single-center prospective cohort study. Ren Fail. 2023; 45(1): 2199097.
  22. Laforge M, Elbim C, Frère C, et al. Tissue damage from neutrophil-induced oxidative stress in COVID-19. Nat Rev Immunol. 2020; 20(9): 515–516.
  23. Draxler A, Blaschke A, Binar J, et al. Age-related influence on DNA damage, proteomic inflammatory markers and oxidative stress in hospitalized COVID-19 patients compared to healthy controls. Redox Biol. 2023; 67: 102914.
  24. Russo A, Tellone E, Barreca D, et al. Implication of COVID-19 on erythrocytes functionality: red blood cell biochemical implications and morpho-functional aspects. Int J Mol Sci. 2022; 23(4).
  25. Georgieva E, Ananiev J, Yovchev Y, et al. COVID-19 complications: oxidative stress, inflammation, and mitochondrial and endothelial dysfunction. Int J Mol Sci. 2023; 24(19).
  26. Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2017; 9(6): 7204–7218.
  27. Buonacera A, Stancanelli B, Colaci M, et al. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022; 23(7).
  28. Salciccioli JD, Marshall DC, Pimentel MAF, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015; 19(1): 13.
  29. Huang Z, Fu Z, Huang W, et al. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020; 38(3): 641–647.
  30. Ciccullo A, Borghetti A, Zileri Dal Verme L, et al. GEMELLI AGAINST COVID Group. Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line. Int J Antimicrob Agents. 2020; 56(2): 106017.
  31. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4): 420–422.
  32. Harbort CJ, Soeiro-Pereira PV, von Bernuth H, et al. Neutrophil oxidative burst activates ATM to regulate cytokine production and apoptosis. Blood. 2015; 126(26): 2842–2851.
  33. Chan L, Karimi N, Morovati S, et al. The roles of neutrophils in cytokine storms. Viruses. 2021; 13(11): 2318.
  34. Chan ASy, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020; 12(7): 448–453.
  35. Simadibrata DM, Calvin J, Wijaya AD, et al. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med. 2021; 42: 60–69.
  36. Santos HO, Delpino FM, Veloso OM, et al. Elevated neutrophil-lymphocyte ratio is associated with high rates of ICU mortality, length of stay, and invasive mechanical ventilation in critically ill patients with COVID-19 : NRL and severe COVID-19. Immunol Res. 2023 [Epub ahead of print].
  37. Goel R, Apostolidis S, Painter M, et al. Distinct antibody and memory B cell responses in SARS-CoV-2 naïve and recovered individuals after mRNA vaccination. Sci Immunol. 2021; 6(58).
  38. Gozhenko A, Szarpak L, Jaguszewski M, et al. COVID-19 vaccine — third dose, booster dose? What is it and is it necessary? Disaster Emerg Med J. 2021; 6(4): 208–209.
  39. Jarjour NN, Masopust D, Jameson SC. T cell memory: understanding COVID-19. Immunity. 2021; 54(1): 14–18.
  40. DiPiazza AT, Graham BS, Ruckwardt TJ. T cell immunity to SARS-CoV-2 following natural infection and vaccination. Biochem Biophys Res Commun. 2021; 538: 211–217.