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Platelet-derived immuno-inflammatory indices show best performance in early prediction of COVID-19 progression
Jelena Milenkovic1, Boris Djindjic1,2, Branka Djordjevic3
1Department of Pathophysiology, Faculty of Medicine University of Nis, Nis, Serbia.
Insights
Platelet and white blood cell count ratios effectively predict COVID-19 progression and mortality. Large immature cell count also shows promise for early identification of severe COVID-19 cases.
Area of Science:
- Hematology
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 significantly impacts immune and hematopoietic systems, altering blood cell counts.
- Immuno-inflammatory indices derived from blood counts can predict COVID-19 outcomes.
- Evaluating these indices is crucial for managing COVID-19 patients.
Purpose of the Study:
- To evaluate and compare leukocyte and platelet count-based immuno-inflammatory indices.
- To determine the predictive value of these indices for COVID-19 progression and mortality.
- To assess the utility of large immature cells (LIC) in early COVID-19 severity identification.
Main Methods:
- Analysis of hemogram-derived immuno-inflammatory indices in 945 COVID-19 patients.
- Statistical testing included ANOVA, ROC curve analysis, and binomial logistic regression.
- Indices were assessed for their association with COVID-19 progression and death.
Main Results:
- Severe COVID-19 cases showed higher neutrophils, eosinophils, LIC, and lower platelets and monocytes.
- Lymphopenia was common but not significantly associated with outcomes.
- Platelets/neutrophil-to-lymphocyte ratio (P/NLR) and platelets-to-neutrophil ratio (P/N) were independent predictors of poor outcomes.
Conclusions:
- Indices combining platelet counts with neutrophil and/or lymphocyte counts demonstrated the best prognostic value for COVID-19 outcomes.
- Large immature cell (LIC) count showed potential for early identification of severe COVID-19.
- These hemogram-derived indices offer a simple yet effective tool for predicting COVID-19 severity and mortality.
Background:
Coronavirus disease 2019 (COVID-19) profoundly affects the immune and hematopoietic systems with various degrees of reactive changes in the blood cell counts. Immuno-inflammatory indices are considered a simple and effective tool in the prediction of COVID-19 outcomes. We aimed to evaluate and compare the usefulness of leukocyte and platelet counts-based immuno-inflammatory indices on admission to hospital in predicting COVID-19 progression and mortality.
Methods:
A total of 945 patients were enrolled. In addition to blood cell counts, we assessed hemogram-derived immuno-inflammatory indices in relation to COVID-19 progression and death. The indices were tested by analysis of variance, receiver operating characteristic curve analysis, and binomial logistic regressions.
Results:
Patients with severe COVID-19 had significantly higher counts of neutrophils, eosinophils, and large immature cells (LIC), while decreased counts of platelets and monocytes. Lymphopenia was found in all of the patients, but without significant association with the outcomes. Patients with a LIC count ≥0.265 x 09 /L had 54.7% more odds of having COVID-19 progression. In multivariable analyses, platelets/neutrophil-to-lymphocyte ratio (P/NLR) and platelets-to-neutrophil radio (P/N) were significant independent predictors of COVID-19 progression and mortality. The odds of a poor outcome were two times higher in cases with P/NLR < 43 x 109 /L and P/N < 29 x 109 /L.
Conclusion:
Indices that include platelet count in combination with neutrophil and/or lymphocyte counts displayed the best discriminatory ability and prognostic value of COVID-19 outcomes. Additionally, LIC showed promising results in the early identification of severe COVID-19.
