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Lymphocyte-to-C-Reactive Protein (LCR) Ratio Is Not Accurate to Predict Severity and Mortality in Patients with
Laure Abensur Vuillaume1, François Lefebvre2, Axel Benhamed3
1Emergency Department, CHR Metz-Thionville, 57000 Metz, France.
Insights
The Lymphocyte-to-C-Reactive Protein (LCR) ratio may help predict severe COVID-19 in the Emergency Department. However, this marker did not show association with overall disease severity or mortality in hospitalized patients.
Area of Science:
- Infectious Diseases
- Clinical Biochemistry
- Epidemiology
Background:
- The COVID-19 pandemic necessitated the identification of prognostic markers for disease severity.
- Lymphocytes and C-Reactive Protein (CRP) have been previously identified as markers of interest in COVID-19.
- The prognostic value of the Lymphocyte-to-C-Reactive Protein (LCR) ratio remains to be fully elucidated.
Purpose of the Study:
- To investigate the prognostic value of the LCR ratio in predicting severity and mortality in hospitalized COVID-19 patients.
- To assess the association between the LCR ratio and COVID-19 disease severity and mortality.
- To determine if the LCR ratio can serve as an early predictive marker for severe COVID-19.
Main Methods:
- A multicenter, retrospective cohort study was conducted involving 1035 hospitalized COVID-19 patients.
- Data were collected from six hospitals in northeast France between March 1 and April 30, 2020.
- The LCR ratio was analyzed in relation to disease severity (moderate vs. severe/ICU admission) and mortality.
Main Results:
- The median LCR ratio was significantly lower in patients with severe COVID-19 compared to those with moderate disease upon Emergency Department (ED) admission (p < 0.001).
- The LCR ratio was not significantly associated with overall disease severity (OR: 0.99, 95% CI: 0.99-1) or mortality (OR: 0.99, 95% CI: 0.99-1).
- An LCR ratio threshold of 12.63 in the ED showed modest predictive value for severe forms of COVID-19.
Conclusions:
- While the LCR ratio is lower in severe COVID-19 cases, it does not appear to be a reliable predictor of overall disease severity or mortality.
- The LCR ratio may serve as a modest, early predictive marker for severe COVID-19 in the ED setting.
- Further research is warranted to validate the LCR ratio's role in COVID-19 patient management.
Abstract:
Health care systems worldwide have been battling the ongoing COVID-19 pandemic. Since the beginning of the COVID-19 pandemic, Lymphocytes and CRP have been reported as markers of interest. We chose to investigate the prognostic value of the LCR ratio as a marker of severity and mortality in COVID-19 infection. Between 1 March and 30 April 2020, we conducted a multicenter, retrospective cohort study of patients with moderate and severe coronavirus disease 19 (COVID-19), all of whom were hospitalized after being admitted to the Emergency Department (ED). We conducted our study in six major hospitals of northeast France, one of the outbreak's epicenters in Europe. A total of 1035 patients with COVID-19 were included in our study. Around three-quarters of them (76.2%) presented a moderate form of the disease, while the remaining quarter (23.8%) presented a severe form requiring admission to the ICU. At ED admission, the median LCR was significantly lower in the group presenting severe disease compared to that with moderate disease (versus 6.24 (3.24-12) versus 12.63 ((6.05-31.67)), p < 0.001). However, LCR was neither associated with disease severity (OR: 0.99, CI 95% (0.99-1)), p = 0.476) nor mortality (OR: 0.99, CI 95% (0.99-1)). In the ED, LCR, although modest, with a threshold of 12.63, was a predictive marker for severe forms of COVID-19.
