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Relationship between neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with the severity of COVID-19
Ida A Arini1, Sri Masyeni2, Ni W Widhidewi3
1Faculty of Medicine and Health Sciences, Universitas Warmadewa, Denpasar, Indonesia.
Insights
Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can predict COVID-19 severity. Higher NLR and PLR levels correlate with more severe disease, offering valuable insights for patient assessment.
Area of Science:
- Infectious Diseases
- Hematology
- Biomarkers
Background:
- Coronavirus disease 2019 (COVID-19) presents a significant global health challenge, particularly for vulnerable populations.
- Inflammatory biomarkers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have shown potential in assessing infection severity.
Purpose of the Study:
- To investigate the association between NLR and PLR and the severity of COVID-19.
- To evaluate the predictive value of NLR and PLR in distinguishing between moderate and severe/critical COVID-19 cases.
Main Methods:
- A cross-sectional study involving 104 COVID-19 patients (aged 18-50, no comorbidities) was conducted.
- Patients were classified into moderate and severe/critical groups based on clinical presentation.
- The Mann-Whitney test was employed to analyze the relationship between NLR, PLR, and COVID-19 severity.
Main Results:
- A significant correlation was found between elevated NLR (p=0.002) and PLR (p=0.001) and increased COVID-19 severity.
- Optimal cut-off values were identified: NLR ≥3.8 (95% sensitivity, 74% specificity) and PLR ≥106 (70% sensitivity, 50% specificity).
- The majority of patients (77.9%) presented with moderate COVID-19 severity.
Conclusions:
- NLR and PLR demonstrate a strong association with COVID-19 severity.
- These ratios serve as promising, accessible biomarkers for predicting disease progression and patient outcomes.
- Further research can explore integrating NLR and PLR into routine clinical assessments for COVID-19 management.
Abstract:
Coronavirus disease 2019 (COVID-19) is an infectious disease that spreads rapidly causing a high case fatality rate in vulnerable populations. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are known to be inflammatory biomarkers in certain infections. The aim of this study was to determine the relationship between NLR and PLR with the severity of COVID-19. A cross-sectional study was conducted at Tabanan Regency General Hospital, Bali, Indonesia, from January 2021 to December 2022. All patients included in the study tested positive for COVID-19 by real-time polymerase chain reaction (RT-PCR), aged 18-50 years with no comorbid. Laboratory examinations were carried out on admission. The patients were categorized into two groups based on the severity: moderate and severe/critical. The Mann-Whitney test was used to determine the association between NLR and PLR with the severity of COVID-19. A total of 104 patients were included in the study, the majority of COVID-19 patients had moderate (77.9%) severity. The average NLR was 5.8 and the PLR was 21.7. There was a significant relationship between NLR (p=0.002) and PLR (p=0.001) with the severity of COVID-19. The defined cut-off values of NLR and PLR were ≥3.8 and ≥106, yielding sensitivities of 95% and 70%, and specificities of 74% and 50%, respectively. This study highlights the promising role of NLR and PLR as predictive biomarkers to assess COVID-19 severity.
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