Neutrophil to lymphocytic ratio and other inflammatory markers as adverse outcome predictor in hospitalized COVID-19 patients

The Egyptian Journal of Immunology
Volume 29 (2), April, 2022
Pages: 57–67.
www.Ejimmunology.org
https://doi.org/10.55133/eji.290207
Shaymaa A. Abdelhady1, Fatma Rageh2, Samar S. Ahmed3, Shimaa A. Al-Touny4, Eman Riad5, Mohamed M. Elhoseeny6, Ahmad A. Khalifa7, Almaza Salim8, Maysa I. farghly9 and Rasha Elgamal9

 

1Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

2Department of Infectious Diseases, Gastroenterology & Hepatology, Faculty of Medicine, Suez University, Suez, Egypt.

3Department of Community Medicine, Occupational & Environmental Medicine, Faculty of Medicine, Suez University, Suez, Egypt.

4Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

5Internal Medicine, Pulmonology Unit, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

6Department of Internal Medicine, Faculty of Medicine, Suez University, Suez, Egypt. 7Department of Radiodiagnosis, Faculty of Medicine, Suez University, Suez, Egypt.

8Department of Family Medicine, Port said University, Port Said, Egypt.

9Department of Clinical Pathology, Faculty of Medicine, Suez University, Suez, Egypt.

Corresponding author: Fatma Rageh, Department of Infectious Diseases, Gastroenterology & Hepatology, Faculty of Medicine, Suez University, Suez, Egypt.
Email: fatma.mohamed@med.suezuni.edu.eg.

Abstract

Early risk classification of coronavirus disease 2019 (COVID-19) patients admitted to hospital is a critical key for providing optimal interventions. We investigated whether neutrophil-to-lymphocyte ratio (NLR) levels and other inflammatory and coagulation markers could be predictors for the severity and mortality of hospitalized COVID-19 patients. This cross-sectional study included 155 COVID-19 patients diagnosed by the reverse transcription polymerase chain reaction (RT-PCR) using oropharyngeal swabs. All patients had clinical examination, routine laboratory investigation, and chest computerized tomography scan. O2 saturation, serum D dimer, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and serum ferritin were assessed. NLR can predict the adverse outcome (e.g., disease deterioration and shock) at cut-off 6.65, with 92% sensitivity and 20.7% specificity. LDH at cut-off value of 364.5 had 79.3% sensitivity and 47% specificity. Ferritin at a cut-off value of 1036 had 60.9% sensitivity and 60.6% specificity. NLR alone was not an independent predictor for ICU, however, combining NLR with ferritin and LDH predicted the need for ICU. Total leucocytic count (TLC), neutrophil count, lymphocytic count, D dimer, and CRP were independent predictors for the need of ICU admission (P <0.05). Admitted patients to ICU and dead patients had higher COVID-19 Reporting and Data System, length of stay, LDH, and ferritin and lower O2 saturation than non-admitted and alive ones. We concluded that NLR with ferritin and LDH markers had higher degree of sensitivity and specificity in detecting adverse outcomes in COVID-19 patients. Other inflammatory biomarkers such as TLC, neutrophil, lymphocyte, D dimer, and CRP were predictive in this case.

Keywords: Neutrophil to Lymphocytic Ratio, Inflammatory Markers, C-reactive protein, Hospitalized COVID-19.

Date received: 28 February 2022; accepted: 22 March 2022.

PMID: 35436055

 

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