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Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A
Xisheng Yan1, Fen Li2, Xiao Wang3
1Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China.
Insights
The neutrophil-to-lymphocyte ratio (NLR) can predict mortality in COVID-19 patients. A high NLR at hospital admission indicates a significantly increased risk of in-hospital death from coronavirus disease 2019.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant global health threat.
- Identifying prognostic factors for COVID-19 outcomes is crucial for patient management.
- The neutrophil-to-lymphocyte ratio (NLR) is an accessible hematological marker.
Purpose of the Study:
- To investigate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor in COVID-19 patients.
- To determine the association between NLR and all-cause in-hospital mortality in COVID-19.
- To evaluate NLR's utility as a biomarker for predicting COVID-19 severity.
Main Methods:
- Retrospective analysis of 1004 COVID-19 patients admitted to Tongren Hospital of Wuhan University.
- Exclusion of patients with hematologic malignancy.
- Calculation of NLR at admission and multivariate logistic regression analysis to assess mortality risk.
Main Results:
- The in-hospital mortality rate was 4.0%.
- Nonsurvivors were older and had a significantly higher median NLR (49.06) compared to survivors (4.11).
- An NLR > 11.75 was strongly correlated with increased all-cause in-hospital mortality (OR = 44.351).
Conclusions:
- Neutrophil-to-lymphocyte ratio (NLR) at hospital admission is a significant prognostic biomarker for COVID-19 outcomes.
- Elevated NLR is associated with increased in-hospital mortality among COVID-19 patients.
- Further prospective studies are warranted to validate the prognostic value of NLR in COVID-19.
Abstract:
This retrospective study was designed to explore whether neutrophil to lymphocyte ratio (NLR) is a prognostic factor in patients with coronavirus disease 2019 (COVID-19). A cohort of patients with COVID-19 admitted to the Tongren Hospital of Wuhan University from 11 January 2020 to 3 March 2020 was retrospectively analyzed. Patients with hematologic malignancy were excluded. The NLR was calculated by dividing the neutrophil count by the lymphocyte count. NLR values were measured at the time of admission. The primary outcome was all-cause in-hospital mortality. A multivariate logistic analysis was performed. A total of 1004 patients with COVID-19 were included in this study. The mortality rate was 4.0% (40 cases). The median age of nonsurvivors (68 years) was significantly older than survivors (62 years). Male sex was more predominant in nonsurvival group (27; 67.5%) than in the survival group (466; 48.3%). NLR value of nonsurvival group (median: 49.06; interquartile range [IQR]: 25.71-69.70) was higher than that of survival group (median: 4.11; IQR: 2.44-8.12; P < .001). In multivariate logistic regression analysis, after adjusting for confounding factors, NLR more than 11.75 was significantly correlated with all-cause in-hospital mortality (odds ratio = 44.351; 95% confidence interval = 4.627-425.088). These results suggest that the NLR at hospital admission is associated with in-hospital mortality among patients with COVID-19. Therefore, the NLR appears to be a significant prognostic biomarker of outcomes in critically ill patients with COVID-19. However, further investigation is needed to validate this relationship with data collected prospectively.
